基于WBB分型的胸腰椎肿瘤整块切除手术的安全性和中期随访结果

目的探讨基于WBB分型的胸腰椎肿瘤整块切除手术的安全性和中期随访结果。方法回顾分析2016年5月至2017年12月北京大学第三医院骨科基于WBB分型行整块切除方法治疗的18例胸腰椎肿瘤患者的临床资料。其中,男8例,女10例;中位年龄43(16~63)岁。肿瘤类型:原发性肿瘤14例,转移性肿瘤4例。6例患者为术后复发予以再次手术。肿瘤累及单节段6例,多节段12例。分析所有患者的一般资料、治疗相关资料以及肿瘤学随访结果。结果所有手术均按照术前计划完成,其中全椎体切除12例,矢状切除6例。手术入路:单一后入路6例,多入路联合12例。术后根据肿瘤标本评估肿瘤切缘:经瘤切缘6例,边缘切缘12例。手术时间(538.0±195.8)min,出血量(1 919.4±1 115.8)ml。后方均采用头尾各2~3节段椎弓根螺钉固定,前方采用钛网+异体骨融合8例,采用钛网+自体骨融合2例,采用3D打印人工椎体8例。12例患者共发生并发症16例次,其中重度并发症6例次,轻度并发症10例次。中位随访时间20.5(6~34)个月。1例患者于术后6个月死于肺栓塞,2例患者出现局部复发,4例患者出现远处转移。结论对于脊柱肿瘤整块切除手术而言,WBB分型可以提供实用可靠的手术方案指导,取得理想的效果,但手术相关并发症不容忽视,手术技术经验和多学科紧密协作是保障疗效的前提条件。

Safety and mid-term follow-up results of en bloc resection for primary and metastatic spine tumors based on Weinstein-Boriani-Biagini classification

Objective To investigate the safety and mid-term follow-up results of en bloc resection for primary and metastatic spine tumors based on Weinstein-Boriani-Biagini (WBB) classification. Methods Date of 18 patients with thoracolumbar spine tumor were retrospectively analyed in Department of Orthopedics, Peking University Third Hospital from May 2016 to December 2017. En bloc resection was performed based on WBB classification. There were 8 males and 10 females with a median age of 43 (16-63)years. Fourteen cases were primary tumors and 4 cases were metastatic tumors. Six cases were recurrent tumors. Six cases of single segment and 12 cases of multilevel were involved. The general data, treatment- related data and oncology follow-up results were analysed. Results All surgeries were accomplished according to the plan using single posterior approach in 6 cases and combined approach in 12 cases. The surgical margins were marginal in 12 cases and intralesional in 6 cases. Surgeries lasted (538.0±195.8) min, with blood loss of (1 919.4±1 115.8) ml. The anterior reconstruction was achieved using titanium mesh cage in 10 cases and 3D-printed titanium vertebral body in 8 cases . Twelve cases suffered a total of 16 complications, 6 cases were major and 10 cases were minor. The median follow-up duration was 19.5 months (range 6-34 months), one case died of pulmonary embolizm 6 months after the surgery, 2 cases experienced local recurrence, 4 cases developed new metastases. Conclusions WBB classification can give practical guidance for en bloc resection in spinal tumors and achieve effective local control while the treatment related complications rate is high. This operation is technically difficult and should be performed in specialized centers.