改良全脊椎切除技术后路一期切除胸椎肿瘤

目的 探讨改良全脊椎切除技术经后路一期切除胸椎肿瘤的可操作性和安全性.方法 自主研制了系列经后路一期全椎体切除手术器械,包括:新型线锯切割器、椎间盘开口器、线锯导引钳和挡板拉钩,将Tomita提出的由前向后全脊椎切除"一步切割法"改良为由内向外"两步切割法",即:先利用椎间盘开口器由脊柱后方、经硬膜和椎体间隙斜行由椎间盘水平向前方穿刺,穿刺至挡板拉钩后.抽出穿刺针,将自制线锯由椎间盘开口器套简内穿过,利用线锯导引钳将线锯由同侧导出,由内向外完成对一侧椎间盘的切割,同样完成邻位椎间盘的切割,上该侧脊柱固定棒,同法完成对侧两个椎间盘的切割.利用该改良全椎体切除技术对5例胸椎肿瘤进行了经后路一期全椎体切除的临床应用研究.5例患者分别为:骨母细胞瘤1例,骨巨细胞瘤2例,恶性血管瘤1例,前列腺癌骨转移1例.结果 5例患者术后神经症状无加重,3例有明显改善,平均手术时间7.6h,平均术中出血量1750ml,无硬膜破裂和脑脊液漏发生.术后平均随访18.2(10～35)个月,截止到随访结束均无复发.结论 应用改良全脊椎切除技术经后路一期切除胸椎肿瘤在技术上是可行的,其可操作性和安全性较传统的Tomita全椎体切除术有明显提高.

Modified total en bloc spondylectomy for thoracic vertebra tumor through single posterior approach

Objective To investigate the practicability and safety of modified total en bloc spondyleetumy(MTES).Methods We had designed a series of novel surgical instruments for MTES inde-pendently,including saw cutter,disc puncture needle with sleeve,the saw leading clamp and protecting re-tractor.The traditional total en bloc spondylectomy(TES),which was reported by Tomita with"one step dis-section"from anteriorly to posteriorly,was modified into"two step dissection"from medially to exteriorly.Firstly,the desired cutting disc was punctured through the plane between dura mater spinalis and disc obliquely with 45°-60° to horizontal plane by using the disc puncture needle with sleeve in posterior-anterior direction.The needle and its sleeve were stopped by the protecting retractor,and then the needle was pulled out and a saw was inserted through the left sleeve.The tip of the inserted saw was led out to the same side by the leading clamp.The disc was cut by saw from medially to exteriorly.The neighboring disc was cut through same procedure.After a spine fixation rod was applied on this side,the residual discs on the oppo-site side were cut as previously described.Five patients with thoracic vertebra tumor were treated by using MTES technique through a single posterior approach.The etiology of the 5 patients included 1 case of osteo-lastoma,2 of giant cell tumor,1 of malignant angeioma,and 1 of metastasis of prostate carcinoma.Results MTES was performed successfully on all patients through a single posterior approach.The neurological deficit in all patients was not aggravated postoperatively.The neurological improvement was seen in 4 pa-tients.The average operative time was 7.6 h,and average blood loss was 1750 ml.No disruption of dural mater and the leakage of cerebrospinal fluid were found.No recurrence of tumor was observed at final follow-up.Conclusion MTES for thoracic vertebra tumor dissection through single posterior approach is technical-ly feasible.Compared with traditional TES,the practicability and safety of MTES has improved significantly.