脊柱转移性肿瘤的手术切除与脊柱稳定性重建

目的观察脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效。方法对29例脊柱转移眭肿瘤患者进行脊椎肿瘤切除减压，单纯植骨或钛网、人工椎体植骨加椎弓根钉棒或钢板螺钉内固定，一期重建脊柱稳定性，术后根据病理结果均给予化疗、放疗和激素等综合治疗。观察术后局部疼痛缓解，脊髓神经功能恢复及脊柱椎节的稳定性情况。结果随访6个月～62个月，平均26个月。所有病人术后局部疼痛缓解，脊髓神经功能无加重损伤，其中12例患者脊髓神经功能得到不同程度恢复。术后影像学检查提示：脊柱内固定物在位，椎体序列恢复良好，椎问高度恢复。结论脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效肯定，适应征具备者应积极手术治疗。

Resection of spinal metastatic tumor and reconstruction of spinal stability

Objective To observe the results of surgical management of resection of spinal metastatic tumor and reconstruction of spinal stability.Methods 29 patients with the spinal metastatic tumor were treated by surgical management of tumor resection and decompression,one-stage reconstructed the destroyed spinal segments.There were 2 surgical approaches for restabiliza-tion: reconstruction of the anterior spinal column and posterior stabilization.Rigid stabilization was then achieved by anterior instrumentation,usually including bone autograft or artificial vertebral body or titanium cage,additional an anterior locking plate,or by posterior instrumentation of using pedicle screw-rod fixation systems or lateral mass screws and rods.Relief of the pain,the function of spinal cord or nerve,and stability of spinal vertebra were monitored.Adjunctive chemotherapy or/ and radiotherapy was given postoperatively.Results Postoperatively,at the average follow-up period of 26 months (ranged from 6 months to 62 months),there were no complications of neurological worsening,hematoma,wound infection.All patients experienced significant palliation of local pain and improved the quality of the remaining life.26 patients showed improvemend of neurological status (at least one grade improvement on Frankel's functional classification).All patients achieved immediate stabilization,and preservation of the ability to sit up in two weeks.Postoperative radiological evaluation revealed that implants were stable,there were no phenomena of prosthesis subsidence,graft dislodgement,or failure restoration of spinal segments height and normal lordosis.Solid bony fusion was obtained in all patients.Conclusion It is an effective treatment for tumor resection,decompression and stabilization of the destroyed spinal segments in the management of spinal metastases in patients.Not only palliative treatment but also surgical intervention should be considered for spinal metastases when it is rationalized for indications of spinal instability,intractable pain and/or acute progressing paresis,and unknown histologic diagnosis.