瘤椎全切与重建治疗胸腰椎肿瘤伴神经功能障碍

目的探讨瘤椎全切与重建,治疗胸腰椎肿瘤伴神经功能障碍的手术适应证及临床疗效。方法1999年1月～2005年12月收治胸腰椎肿瘤伴神经功能障碍16例。男10例,女6例;年龄16～62岁,平均31.5岁。原发肿瘤10例,其中骨巨细胞瘤4例,软骨肉瘤3例,动脉瘤样骨囊肿术后复发2例,骨肉瘤1例;转移瘤6例。肿瘤侵犯T53例,T6、T6、7、T9、T11、L2、L4及L5各1例,T8、L1及L3各2例。Tomita外科分型：4型9例,5型6例,6型1例。Frankel神经功能分级：A级1例,B级4例,C级7例,D级4例。采用前后路联合手术,行瘤椎彻底切除,椎管减压,植骨重建。术后根据肿瘤病理类型行相应的辅助治疗。结果术后16例获随访10～63个月,平均27.5个月。患者疼痛均完全缓解,术后神经功能恢复至D级5例（其中1例术前为A级）,E级11例。10例原发肿瘤中,1例骨肉瘤术后18个月双肺转移死亡,余9例均无瘤生存。6例转移瘤中,2例全身转移死亡,1例术后10个月肺部带瘤无症状生存,3例均无瘤生存。16例随访期内手术部位均无肿瘤复发。结论瘤椎全切与重建是治疗胸腰椎肿瘤伴神经功能障碍的一种安全有效的手术方法,可缓解疼痛,改善神经功能,减少肿瘤局部复发。手术适用于胸腰椎原发恶性肿瘤,有复发倾向的侵袭性肿瘤及Tomita外科分型为3～5型的胸腰椎单发转移瘤。

TOTAL SPONDYLECTOMY AND RECONSTRUCTION FOR THORACOLUMBAR SPINAL TUMORS WITH NEUROLOGICAL DEFICIT

Objective To elucidate the surgical indications and treatment outcome of total spondylectomy and reconstruction for thoracolumbar spinal tumors with neurological deficit.Methods From January 1999 to December 2005,16 patients with thoracolumbar spinal tumors with neurological deficit were treated with total spondylectomy and reconstruction.There were 10 males and 6 females,with an average age of 31.5 years(16-62 years).There were 10 cases of primary tumors of spine(4 giant cell tumor of bone,3 chondrosarcoma,2 recurrent aneurysmal bone cyst,and 1 osteosarcoma),and 6 cases of solitary metastasis of thoracic or lumbar spine.Tomita's surgical classification was as follows:9 cases of type 4,6 of type 5,and 1 of type 6.Frankel's neurological classification was as follows:grade A in 1 case,B in 4,C in 7,and D in 4.All patients were treated with total spondylectomy and reconstruction through combined anterior and posterior approach.Results All patients were followed up from 10 to 63 months with an average of 27.5 months.Pain was relieved completely in all patients.The neurological function returned to grade D in 5 cases,to grade E in 11 cases.Among the 10 patients with primary spinal tumor,nine patients survived with tumor-free,and one with osteosarcoma died because of lung metastases 18 months after surgery.Among the 6 patients with spinal metastasis,three patients survived with tumor-free,and lung metastasis occurred in 1 case 10 months after surgery,two died because of multiple metastases of internal organs 10 months and 32 months after surgery.Conclusion Total spondylectomy and reconstruction is a safe and effective surgery for thoracolumbar spinal tumors with neurological deficit,with pain relief,neurological improvement and minimum tumor recurrence.It will be an optimal choice for patients with primary malignant,aggressive benign,or solitary metastatic bone tumors of the thoracolumbar spine with Tomita surgical classification type 3 to 5.