胸腰椎恶性肿瘤的外科分区及手术治疗

目的：探讨在WBB分区指导下的病椎切除术在胸腰椎恶性肿瘤外科治疗中的临床应用。方法：对我院自2002年3月～2006年3月收治的42例胸腰椎恶性脊柱肿瘤患者的病历资料进行回顾性分析，其中骨髓瘤4例，骨巨细胞瘤9例，脊索瘤2例，骨转移瘤27例。行椎板减压姑息性手术治疗5例，行椎体及附件病灶刮除手术治疗13例，行椎体附件肿瘤切除术7例，行全椎体切除术治疗11例，行一期后路或前、后联合入路全脊椎切除手术治疗6例。结果：36例（85．7％）患者术后腰背部疼痛症状减轻或消失，20例（47．6％）患者术后神经功能得到改善。病灶刮除的13例患者中有5例分别于术后第3、6和12个月复诊时发现局部复发，接受二次手术治疗。本组病例术中、术后无严重并发症发生，全脊椎切除的6例患者截至最近随访时，未发现肿瘤复发，植骨融合，内固定稳定。结论：根据WBB分区系统完成的胸腰椎恶性肿瘤手术治疗策略，特别是全脊椎切除术是治疗恶性脊柱肿瘤的一种有效外科手段。

Surgical classification and treatment for thoracic and lumbar malignant tumors

Objective： To investigate the surgical treatment with vertebral excision, especially the total spondylectomy by WBB classification for thoracic and lumbar malignant tumors. Methods： The clinic records of 42 patients with malignant tumors of thoracic and lumbar spine who underwent surgical treatment has been reviewed retrospectively from March 2002 to March 2006. Among the 42 patients, 4 myeloma, 9 giant cell tumor, 2 chordoblastoma, and 27 metastatic tumor. 5 out of 42 patients have had palliative decompression with laminectomy. 13 patients have had intralesional curettage, graft and instrument. 7 patients have had posterior arch resection, graft and instrument. 11 patients have had somectomy, graft and instrument; 6 patients have had total spondylectomy, graft and instrument through posterior procedure alone or one-stage antero-posterior combined procedure. Results： Remarkable pain was relieved or disappeared after surgery in 36 patients （85.7%） and neurological function was improved in 20 patients （47.6%）. 5 of the 13 intralesional curettage had local recurrence at 3, 6, and 12 months follow-up visit, they un- derwent second operation and no serious complications occurred. No recurrence case was found in the total spondylectomy group at the latest follow up, and what is more with good graft and instrument. Conclusion： The surgical strategy based on WBB classification, especially total spondylectomy, has been proved to be one of the most effective surgical therapies for thoracic and lumbar malignant tumors.