脊柱肿瘤的手术治疗及稳定性重建

目的探讨手术治疗脊柱肿瘤的方法及术后稳定性重建问题.方法对84例脊柱肿瘤患者分别进行不同入路的刮除、切除、脊髓减压手术,通过植骨、骨水泥充填、人工椎体置换等方法进行脊柱稳定性的重建.47例恶性肿瘤患者经综合治疗后,通过缓解程度判定疗效.结果术后平均随访4年5个月,57例肿瘤切除彻底,植骨愈合良好,骨水泥及人工椎体固定牢靠,无松动移位.47例恶性肿瘤经放化综合治疗后,CR 14例,PR 16例,MR 8例,NC 9例.结论手术治疗脊柱肿瘤对抢救截瘫、缓解症状有很大意义,应根据肿瘤的性质、节段和类型选择手术治疗方式,对椎体肿瘤全切除的病例行人工椎体置换和自体植骨术联合后路固定可保持术后的脊柱稳定性.

Study of surgical operation for treatment of benign and malignant spinal tumors and spine reconstruction

Objective To explore the methods of diagnosis and surgical treatment of benign and malignant spinal tumors.Methods Eighty-four cases with benign and malignant tumors of the cervical vertebrae,the thoracic vertebrae and the lumbar vertebrae were treated by resection,curettage and decompression through anterior or/and posterior approach.Stabilization reconstruction was achieved by bone graft,bone cement and artificial vertebral body replacement.The malignant tumor patients were given combined after treatment operation.Results Sixty-two cases were followed up for 4 years and 5 months in average.Forty-seven cases were treated with radiotherapy,chemotherapy,and combination of hormones.The results of treatment were 14 cases of CR, 16 cases of PR,8 cases of MR and 9 cases of NC.Eighty cases were followed up with radiography from 6 months to 36 months.Fifty-seven cases received thorough resection of tumors and the bone cement and artificial vertebral,were not loosened and displaced.Conclusion The surgical treatment of the spinal tumors was important for salvage of paraplegia and relieving symptoms,and was decided according to the spinal segment and types of tumors.Artificial vertebral body replacement and bone graft for the patients with spinal tumors are required for adequate tumor removal and stabilization of the spine reconstruction.