前路U形钛板在腰骶段脊柱肿瘤切除术后稳定性重建中的应用

目的:评价U形钛板在前路腰骶段肿瘤切除脊柱稳定性重建手术中的应用效果。方法:21例腰骶椎肿瘤患者均采取前方手术入路,肿瘤切除后6例良性肿瘤患者应用自体髂骨植骨、钛板内固定,15例恶性肿瘤患者采用骨水泥填充、钛板内固定。随访观察治疗效果。结果:所有患者随访8～24个月,平均16个月,腰骶部疼痛及骶神经压迫症状均明显改善,6例良性肿瘤患者3个月后均达骨性融合;15例应用骨水泥填充治疗的恶性肿瘤患者内置物位置良好无移位,1例患者术后16个月死于肺转移,1例术后未坚持放化疗,3个月后局部复发,出现瘫痪症状,余13例未见肿瘤局部复发和转移。所有患者内固定无松动和断裂。结论:前路腰骶段脊柱肿瘤切除后应用骨水泥或自体髂骨植骨加前路钛板内固定有利于维持脊柱及骨盆的连续性,可前路一期完成减压和稳定性重建,固定牢靠,创伤较小,是腰骶段脊柱稳定性重建可选择的方式之一。

Application of anterior reconstruction with U-shape titanium-plate in lumbosacral tumor

Objective:To investigate the clinical effectiveness of a new U-shape titanium-plate technique used in the anterior surgery of the lumbosacral tumor.Method:21 patients with lumbosacral tumor were treated from anterior approach.In all of cases the titan-plates were used as anterior internal fixator.To fuse the spine,bone grafting was used in 6 cases with benign tumor and bone cement was used in 15 cases with malignant tumor.Result:All cases were followed up for an average of 16 months(8~24months),the pain arised from the lumbar-sacrum joint and the spinal nerve root was relieved obviously.Bone grafts fused solidly and bone sements were in right position after 3 month in 6 cases.One patient died of lung metastasis 16 months after surgery.Another patient was paralyzed due to stopping at chemotherapy and local recurrence of the tumor.Neither recurrence nor metastasis was seen in the rest cases.There was no failure of the screw or the plate.Conclusion:Lumbosacral tumor resection and anterior reconstruction with titan-plate and bone graft/cement is an effective method which provides solide stabilization and less trauma,significant pain relief and can improve the neural function.