胸腰椎肿瘤切除人工椎体置换术

目的 观察人工椎体置换术治疗胸腰椎肿瘤的疗效。方法 行肿瘤切除人工椎体置换术治疗胸腰椎肿瘤8例，其中血管瘤1例，骨巨细胞瘤1例，骨肉瘤1例，淋巴肉瘤1例，转移性肿瘤4例；T5 1例，T5.6 1例，T12 2例，L2 2例，L3 2例。结果 随访4～36个月，术前5例胸腰背疼痛伴下肢痛者，4例术后疼痛完全消失，1例胸腰背痛减轻、下肢痛消失；截瘫基本恢复正常。结论 人工椎体置换术是治疗胸腰椎肿瘤的理想方法。     

强迫性侧卧位下经皮椎体成形术治疗腰椎转移性肿瘤

目的 探讨强迫性侧卧位下行经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗腰椎转移性肿瘤的手术技巧及临床疗效.方法 回顾性分析2014年12月至2015年12月于我科治疗的因无法耐受俯卧位而采用强迫性侧卧位下行PVP的6例腰椎转移性肿瘤病人,收集统计所有病人的手术前后影像学资料、疼痛视觉模拟量表(visual analogue scale,VAS)评分及肿瘤复发情况,评价强迫性侧卧位下PVP治疗腰椎转移性肿瘤的临床疗效.结果 本组病人手术时间为16~32 min,平均为(24.4±4.3)min.病人均获得随访,随访时间为6~12个月,平均为(10.0±2.0)个月.术后所有病人至末次随访均未见肿瘤破坏加重,其中2例病人于术后6~7个月死于多器官功能衰竭.所有病人术前、术后影像学资料完整,均无骨水泥外漏,术中无骨水泥反应,术中、术后无脊髓、神经根损伤等并发症发生,术后无穿刺部位感染.病人术前VAS评分为(6.6±1.3)分,与术后的(1.9±1.1)分比较,差异具有统计学意义(P<0.05).结论 腰椎转移性肿瘤病人采用强迫性侧卧位,行PVP手术可有效缓解病人疼痛,取到较好的临床疗效.     

DynaCT在经皮椎体成形术治疗椎体转移性肿瘤中的应用价值

目的:探讨DynaCT在经皮穿刺椎体成形术治疗椎体转移性肿瘤中的应用价值.方法:2006年12月～2008年1月共收治伴有不同程度腰背部疼痛的椎体转移性肿瘤患者12例,年龄42～77岁,平均54.7岁.病变椎体共计14个,其中胸椎5个,腰椎9个,CT提示均有溶骨性破坏.均行经皮椎体成形术治疗,术前采用DynaCT技术成像观察椎体骨皮质连续性并和螺旋CT扫描比较,术中采用DynaCT技术成像帮助引导进针,术后根据WHO标准观察镇痛效果,分别使用DynaCT和螺旋CT观察骨水泥渗漏情况,并进行比较.结果:术前DynaCT和螺旋CT扫描显示骨皮质完整情况完全一致,共9个椎体10处骨皮质不连续,其中9处为骨皮质破坏、1处为粗大引流静脉.14个椎体中,8个行单侧椎弓根穿刺注射,6个行双侧椎弓根穿刺注射,均穿刺成功.每个椎体骨水泥注射量2.0～6.0ml,平均3.6ml.术后8例患者疼痛完全缓解(CR),4例部分缓解(PR),有效率100%.DynaCT和螺旋CT重建图像显示的骨水泥渗漏情况完全一致,14个椎体中10个出现骨水泥渗漏,其中3个渗漏至椎旁软组织,4个渗漏入椎旁静脉丛,1个渗漏至椎间隙,1个渗漏入椎管,1个同时渗漏至椎旁静脉丛和椎间隙,渗漏率71.4%,但无1例出现相关症状.10处骨皮质不连续中6处出现骨水泥渗漏.结论:应用DynaCT引导可以确保穿刺准确性,观察骨皮质连续性和骨水泥渗漏的作用和螺旋CT相同.     

椎弓根内固定联合椎体成形术治疗腰椎转移性肿瘤

目的探讨使用椎弓根内固定系统同时直视下行椎体成形术治疗腰椎转移肿瘤的临床疗效。方法2006年4月至2009年10月共治疗腰椎转移性肿瘤10例．共16个椎体,患者均有顽固性腰痛和下肢神经症状,所有患者均行椎管减压及病椎的椎体成形术治疗。随访观察治疗效果。结果所有患者术后腰痛及下肢神经症状明显缓解。10例患者均行4钉2棒内固定,术中均在c型臂的透视下置钉。16个病椎减压后直视联合C型臂透视均一次穿刺成功,双侧注射10个椎体,平均注入量5．2mI．;单侧注射6个椎体,平均3．8mI,。4例出现椎体后壁局部渗漏,直视下立即清除后,无神经损伤加重情况发生。随访5～20个月,平均12．5个月。1例肺癌转移患者术后10个月左右出现肿瘤复发,其余患者手术椎体未出现新的病理性骨折及神经症状加重。结论椎弓根内固定联合椎体成形术治疗腰椎转移性肿瘤能有效的改善患者的生存质量,预防病理性骨折的发生,是一种行之有效的方法。     

经皮穿刺椎体成形术治疗胸腰椎椎体转移性肿瘤

目的探讨经皮穿刺椎体成形术（percutaneous vertebroplasty,PVP）对胸腰椎椎体转移性肿瘤疼痛的疗效及其安全性。方法 23例胸腰椎转移性肿瘤患者的48个受累椎体,其中单个椎体转移6例,2个椎体转移9例,3个椎体转移8例;病变位于胸椎5例,位于腰椎7例,位于胸腰椎11例;所有患者均有不同程度的腰背部疼痛,3例有轻度神经症状。对48个病椎施行PVP,采用视觉模拟评分法（visual-analoguescale,VAS）对患者治疗前后的疼痛状况进行评估、分级。术后1周、3个月、6个月进行常规随访,评价疼痛缓解程度。结果 23例患者中15例术后局麻药药效消失后疼痛缓解,5例24 h后疼痛缓解,3例48 h后疼痛缓解。11例无骨水泥渗透,另12例出现骨水泥渗漏,其中2例术后出现神经根症状。23例全部获得随访,随访时间6～25个月,平均随访14.6个月,均无椎体进一步压缩、滑脱等改变。术后1周的优良率为75%,有效率为85%;术后3个月的优良率为70%,有效率为80%;术后6个月的优良率为55%,有效率为65%。结论 PVP对胸腰椎椎体转移性肿瘤疼痛具有良好的止痛效果,能有效预防受累椎体进一步压缩,手术简单安全,可有效改善患者的生存质量。     

肿瘤椎体切除人工椎体置换脊柱重建术

目的 探讨肿瘤椎体切除人工椎体置换脊柱重建的有关问题。方法 分析5例手术治疗的临床资料;复习国内文献资料。结果 5例术后6－12个月重建椎体骨性融合,其中1例前列腺癌术后26个月死于肺转移。国内文献32例,1例术后3天死于心衰和肺部感染;31例重建椎体骨性融合,其中3例螺钉松动。结论 肿瘤椎体切除,采用人工椎体置换可重建脊柱支撑;不管椎体肿瘤是原发还是转移,凡能耐受手术者均应尽早手术;假体内外植骨才能牢固融合;术前节段性椎动脉栓塞,术中采用控制性低血压,可减少出血量。     

CT引导下经皮椎体成形术治疗胸椎转移性肿瘤

目的:探讨CT引导下经皮椎体成形术治疗胸椎转移性肿瘤的安全性及疗效.方法:2004年4月～2006年2月共治疗胸椎转移性肿瘤患者18例.共30个椎体,患者均有顽固性胸背痛,术前VAS评分平均8.6分,伴脊髓压迫者6例,术前Frankel分级C级2例,D级4例,均应用CT引导下经皮椎体成形术行病变椎体内骨水泥注射治疗.随访观察并发症发生情况及治疗效果.结果:30个椎体存CT引导下均一次穿刺成功.单侧注射骨水泥12例,平均注入量2.75ml;双侧注射6例,平均注入量4.7ml,无骨水泥渗漏及神经损害加重情况发生.15例局麻药效消失后疼痛明显缓解,2例72h后疼痛缓解,1例无效.随访6～24个月,平均11.4个月.术后1周时VAS评分平均2.62分,末次随访时VAS评分平均2.94分,与术前比较均有显著改善(P<0.01).末次随访时6例脊髓压迫者神经功能2例C级恢复至D级,其余均恢复至E级.2例原发灶为肝痛及1例肺癌患者死亡,其余患者手术椎体未发生新的病理性骨折及脊髓压迫加重.结论:CT引导下经皮椎体成形术具有良好的止痛及预防病理性骨折作用,是治疗胸椎转移性肿瘤安全、有效的方法.     

腰痛患者L5椎体发育不良与腰椎退行性变的关系

目的 探讨L₅椎体发育不良(L₅ vertebral dysplasia, L₅VD)的发生率及其与腰痛患者退行性变的关系。方法 选择67例L₅VD患者作为研究组,按照1∶5比例从剩余患者中选择335例非L₅VD患者作为对照组。观察患者L₅椎体参数、L_4-5椎间盘退变、L₅-S₁椎间盘退变、L₅椎体上下终板Modic变化、L₅峡部裂和椎体滑脱的发生率。结果 L₅VD检出率为1.97%。研究组L₅椎体前后位直径、L₅椎体后缘高度低于对照组,L₅椎体楔角高于对照组,差异均有统计学意义(P<0.05)。研究组L_4-5、L₅-S₁椎间盘Pfirrmann分级的高级别占比均高于对照组(P<0.0...     

Lumbar fractures involving five vertebrae: a case report

We report a 20-year-old man who sustained lumbar fractures involving 5 vertebrae following a road traffic accident. He was initially treated non-operatively to allow multiple pedicles to heal. He developed post-traumatic kyphosis for which corrective osteotomy and posterior spinal instrumented fusion was performed. He achieved a good functional outcome. We emphasise the need for careful radiological evaluation in patients with high-energy trauma, and the option of treating such complex injuries by non-operative means. If post-traumatic kyphosis develops, it can be dealt with later and the most mobile segments of the lumbar spine can be preserved.     

Aortic replacement during post chemotherapy retroperitoneal residual tumor resection for nonseminomatous germ cell tumor: a case report

A 59-year-old man visited our hospital complaining of epigastralgia. A large hard mass was palpable in the abdominal cavity. Abdominal computed tomography revealed large retroperitoneal cystic tumors. His left testis was hard and swollen. Under the diagnosis of testicular tumor and retroperitoneal lymph node metastasis, left radical orchiectomy was performed and the histopathological examination showed mature teratoma. He was diagnosed with nonseminomatous germ cell tumor and retroperitoneal lymph node metastasis (TNM classification stage IIC). He received three cycles of chemotherapy with bleomycin, etoposide, and cisplatin and we performed retroperitoneal residual tumor resection. Because the tumor tightly adhered to the aortic wall, abdominal aorta was resected and replaced by an artificial vessel. The post-operative course was uneventful. Histopathological diagnosis was cystopapillary adenocarcinoma and mature teratoma. The patient is well 1 and a half years after the operation without recurrence.     

Artificial nucleus replacement: clinical experience

The prosthetic disc nucleus is designed to help treat patients suffering from degenerative disc disease. The device consists of a hydrogel core that is encased in a polyethylene jacket and is intended to restore disc height while permitting normal range of motion. Clinical trials for the prosthetic disc nucleus were first conducted in 1996, and the device was found to be effective in most of the patients that were implanted. Additional trials in 1997-1998 were less successful, with 38% of patients requiring revision surgery because of device migration. Subsequent changes were made to device shapes and to the surgical protocol to facilitate implantation, thereby eliminating the high device migration rates. Following these modifications, the success rate for the device has improved significantly. Clinical data show excellent results with marked improvements in Oswestry and Prolo scores. Overall, disc height measurements have been well maintained within normal physiologic ranges. The prosthetic disc nucleus device is currently undergoing clinical trials in Canada, and an IDE application to the Food and Drug Administration was expected in the fall, 2001.     

Primary carcinoid tumor of the testis with metastasis to the upper vertebrae. Report of a case

A case of primary carcinoid tumor of the right testis with metastases to the cervical and thoracic vertebrae and epidural is reported. A 53-year-old man was first recognized as being with dysthesia of the left arm and shoulder in April 1986. In June, 1987, he was admitted to the Neurology service, complaining of sudden occurrence of abasia. Myelography and computerized tomography demonstrated an epidural mass and several high density areas in the vertebral bodies of Th1 and Th2. The patient underwent laminectomy from C7 to Th2. At operation, the neurosurgeons noticed a tumor mass in the right scrotum and requested our consultation. Thus right high orchiectomy was performed. Pathological examination including Grimerius' and Fontana-Masson's stain revealed carcinoid tumor of the right testis associated with metastases to the spinal column. Postoperatively, tumor maker studies revealed elevation of blood 5-hydroxytryptophan and marked increase of urinary 5-hydroxy-indoleacetic acid excretion. They showed remarkable decreases after a course of PVB chemotherapy. The patient has been under our observation as an out-patient for the past 27 months with metastases. This is the first case of primary carcinoid tumor of the testis with metastases so far reported in the domestic literature.     

Giant cell tumor of fifth lumbar vertebrae: two case reports and review of the literature.

BACKGROUND CONTEXT: complete or total en bloc spondylectomy has been recommended for giant cell tumors of the spine. Wide local resection of the fifth lumbar vertebra carries potential risks of major complications because of its anatomical features. Only nine cases of the giant cell tumors involving the fifth lumbar vertebra have been reported in the literature. PURPOSE: to present two cases of giant cell tumor of the fifth lumbar vertebra treated by single-stage combined anterior and posterior tumor resection over 7 years of follow-up. STUDY DESIGN: Case report and a review of literature. METHODS: A 33-year-old female and a 20-year-old female, each diagnosed with giant cell tumor of fifth lumbar vertebra, underwent single-stage tumor resection through a combined posterior and retroperitoneal anterior approach. RESULTS: The resection of the fifth lumbar vertebra was completed in the first case without major perioperative complications. In the second case, massive bleeding during the anterior procedure for resection of the vertebral body interrupted the total resection of the tumor, resulting in possible residual tumor which required adjuvant radiotherapy. The patients recovered both clinically and neurologically after the operation. Spinal reconstruction was maintained, and no recurrence of the tumor was evident at the 7-year and 8-year follow-up, respectively. CONCLUSION: There was no recurrence of the tumor after the combined single-stage anterior and posterior tumor resection and adjuvant radiotherapy for the second case for over 7 years follow-up. However, complete resection of the vertebra and tumor at the fifth lumbar vertebra is still challenging to accomplish.     

Metastatic testicular tumor requiring inferior vena cava resection with polytetrafluoroethylene graft replacement: a case report]

A 31 year-old man with a biopsy-proved retroperiotoneal yolk sac tumor was referred to our clinic. Physical examination revealed a thum- tip sized left supra-clavicular mass, a huge right abdominal mass and a tiny hard mass of the right testis. On CT scan, the abdominal tumor, 13 cm in diameter, encircled the inferior vena cava. Serum levels of LDH, AFP and hCG-beta were 2,585 U/l, 19,922 ng/ml and 6.6 ng/ml, respectively. No visceral metastasis was found. Following the right high orchiectomy, 4 cycles of VIP chemotherapy consisting of ifosfamide, etoposide and cisplatin were given, which resulted in partial response of the retroperitoneal mass and complete regression of the supraculavicular node with normalization of all tumor markers. Thus, retroperitoneal lymph node dissection was carried out. Because of the marked adhesion to the tumor, the inferior vena cava was segmentally resected together with the tumor, which was followed by reconstruction of the vena cava using a 16 cm long polytetrafluoroethylene graft, since no collateral venous route was found on the pretreatment venacavography. Histologically, the tumor was nearly necrotic with mature teratoma in small part. Postoperative clinical course was uneventful except feeling of numbness at the right tip toe, and the inferior vena cava has been patent 18 months after the operation with no evidence of recurrence.