颈胸段脊柱肿瘤的外科治疗

目的 观察比较不同手术入路方法治疗颈胸段脊柱肿瘤的疗效。方法 本组９例,共１０例次。对其中４例肿瘤同时累及椎体及椎体后部结构的患者,选择前后路同期手术,经前路切除肿瘤、椎管减压及钢筋骨水泥或前路钢板固定,并同期行后路肿瘤切除术,其中１例行Ｌａｕｑｕｅ棒固定;对４例肿瘤仅累及椎体者,选择经前路切除肿瘤、椎管减压、钢筋骨水泥固定;另２例肿瘤单纯累及椎体后部结构者,经后路行肿瘤切除和椎管减压术。术后４例     

选择性腰动脉栓塞全脊椎切除重建术治疗腰椎骨巨细胞瘤

目的 探讨选择性腰动脉栓塞全脊柱切除及稳定性重建治疗腰椎骨巨细胞瘤的疗效。方法2例腰椎骨巨细胞瘤患者采用术前选择性腰动脉介入栓塞,全期手术行全脊椎切除、前后路联合重建脊柱稳定性的治疗方案。结果 2例术后均获得15个月随访,神经功能恢复满意,植入椎体获得骨性融合,脊柱稳定性良好。结论 选择性腰动脉栓塞下全脊椎切除,前后路联合重建脊柱稳定性治疗腰椎骨巨细胞瘤出血少,疗效满意。     

脊柱肿瘤的手术治疗

目的 :探讨对于脊柱肿瘤一期全脊椎切除及脊柱稳定性重建的手术方法和临床效果。方法 :对 12例脊柱肿瘤行前、后路或前、后联合入路Ⅰ期全脊椎切除、脊髓减压 ,椎间植骨融合、内固定术。结果 :术后 11例获得随访 ,按照Frankel分级较术前均有 1级以上提高 ,所有患者局部疼痛症状消失。术后复查平均植骨融合时间 3个月。1例脊索瘤术后 1年复发 ,1例巨细胞瘤术后 9个月复发。结论 :针对脊柱肿瘤的性质、部位 ,通过不同的手术入路行一期全脊椎切除、植骨融合内固定 ,彻底切除肿瘤 ,重建脊柱稳定性并体现了个体化的治疗方向     

脊柱肿瘤的全脊椎切除术及脊柱稳定性重建

目的探讨对脊柱肿瘤行全脊椎切除术的可行性与临床价值,以及重建脊柱稳定性的可靠方法。方法对27例椎体和附件结构均遭破坏的脊柱肿瘤采用全脊椎切除及内固定重建技术进行治疗,其中包括上颈椎至下腰椎的良、恶性及转移性肿瘤,手术切除1～3节脊椎。结果23例获完整随访,随访时间7～96个月(平均25个月)。1例L5恶性神经纤维瘤及1例C6,7巨细胞瘤于术后10个月及12个月复发,患者放弃治疗;1例C2～4脊索瘤术后1年复发,再次手术效果良好;其余20例未见复发。25例术前伴神经功能损害者,术后有23例获显著改善。结论全脊椎切除术为治疗全脊椎受累脊柱肿瘤的有效方法;切除1～3节脊椎的脊柱可由相应内固定系统进行可靠的稳定性重建。     

后路一期全脊椎切除术治疗复发性脊柱肿瘤

目的 探讨后路一期全脊椎切除术在治疗复发性脊柱肿瘤中的临床应用.方法 2010年1月至2013年10月共6例复发性脊柱肿瘤患者在中山大学孙逸仙纪念医院骨科接受后路一期全脊椎切除术.其中男性3例,女性3例;年龄27 ～ 46岁,平均33.2岁.肿瘤位于胸椎5例,腰椎(L1)1例.病理包括骨巨细胞瘤3例,乳腺癌、鼻咽癌、肺癌骨转移各1例.分析6例患者手术时间、出血量、切除节段、手术切缘、神经功能及手术并发症发生情况.结果 切除1节段1例,2节段2例,3节段3例.手术时间7.5～12.0 h,平均8.9h;出血量2500～4500 ml,平均3 116 ml;无手术相关脊髓损伤.术后病理证实边缘无残留.无围手术期死亡病例.合并硬膜撕裂1例,胸膜破裂2例,胸腔大量积血1例.随访12 ～47个月,平均随访23.2个月;至末次随访未发现局部复发.美国脊髓损伤协会神经功能分级:3例术前E级患者术后仍为E级,2例术前C级患者术后恢复至D级,1例术前B级患者无明显恢复.结论 部分复发性脊柱肿瘤仍适合后路全脊椎切除术,但需严格选择手术适应证.     

脊椎血管瘤目的外科治疗策略

[目的]探讨脊椎血管瘤的外科治疗策略.[方法]回顾1997年10月～2008年10月间的33例脊椎血管瘤.女19例,男14例;平均年龄54岁.13例患者因局部疼痛就诊;12例截瘫;8例存在神经根刺激症状和局部疼痛.9例患者为单纯局部疼痛,影像学无脊髓及神经根压迫,行经皮椎体成形术.24例患者存在硬膜囊或神经根压迫、软组织包块较大、或脊柱不稳,接受开放手术.其中,9例肿瘤主要侵犯椎体、伴有不同程度椎体压缩骨折或存在椎旁软组织包块,行前路手术治疗;12例肿瘤主要累及附件及椎体后缘.肿瘤突入椎管内压迫脊髓及神经根而无明显椎体压缩骨折,行后路手术,其中4例椎体内病灶较大,术中直视下行椎体成形术;3例肿瘤广泛累及椎体及附件,肿瘤侵入椎管内,椎体侧方存在软组织包块,行前后路联合手术.3例术前行节段动脉栓塞术.[结果]9例行单纯椎体成形的患者无围手术期并发症,平均随访41个月,疼痛均完全或明显缓解.开放手术的24例,无围手术期死亡患者.前路手术平均出血为2 739 ml,后路手术平均出血为1 619 ml(P=0.12).1例腰椎前路手术患者术后出现椎体周围血肿并继发下肢静脉血栓.1例胸椎后路手术患者术后出现血肿后截瘫加重.1例腰椎后路手术患者出现伤口感染.19例患者开放手术前存在疼痛,手术后17例疼痛完全或明显缓解.12例截瘫患者的Frankel脊髓功能评分提高1～2级.行开放手术患者平均随访48个月.X线片示内固定物无移位、折断.1例死于其他肿瘤.影像学证实肿瘤复发或发展者4例,2例尤症状给予观察,1例因疼痛行放疗,1例因截瘫再次手术.[结论]根据脊椎血管瘤患者症状产生的病因以及患者一般情况,应用多种相应外科技术治疗脊椎血管瘤,可以取得较好的临床效果.     

胸腰椎恶性肿瘤的外科分区及手术治疗

目的：探讨在WBB分区指导下的病椎切除术在胸腰椎恶性肿瘤外科治疗中的临床应用。方法：对我院自2002年3月～2006年3月收治的42例胸腰椎恶性脊柱肿瘤患者的病历资料进行回顾性分析，其中骨髓瘤4例，骨巨细胞瘤9例，脊索瘤2例，骨转移瘤27例。行椎板减压姑息性手术治疗5例，行椎体及附件病灶刮除手术治疗13例，行椎体附件肿瘤切除术7例，行全椎体切除术治疗11例，行一期后路或前、后联合入路全脊椎切除手术治疗6例。结果：36例（85．7％）患者术后腰背部疼痛症状减轻或消失，20例（47．6％）患者术后神经功能得到改善。病灶刮除的13例患者中有5例分别于术后第3、6和12个月复诊时发现局部复发，接受二次手术治疗。本组病例术中、术后无严重并发症发生，全脊椎切除的6例患者截至最近随访时，未发现肿瘤复发，植骨融合，内固定稳定。结论：根据WBB分区系统完成的胸腰椎恶性肿瘤手术治疗策略，特别是全脊椎切除术是治疗恶性脊柱肿瘤的一种有效外科手段。     

胸腰椎恶性肿瘤的外科分区及手术治疗

目的：探讨在WBB分区指导下的病椎切除术在胸腰椎恶性肿瘤外科治疗中的临床应用。方法：对我院自2002年3月～2006年3月收治的42例胸腰椎恶性脊柱肿瘤患者的病历资料进行回顾性分析,其中骨髓瘤4例,骨巨细胞瘤9例,脊索瘤2例,骨转移瘤27例。行椎板减压姑息性手术治疗5例,行椎体及附件病灶刮除手术治疗13例,行椎体附件肿瘤切除术7例,行全椎体切除术治疗11例,行一期后路或前、后联合入路全脊椎切除手术治疗6例。结果：36例（85．7％）患者术后腰背部疼痛症状减轻或消失,20例（47．6％）患者术后神经功能得到改善。病灶刮除的13例患者中有5例分别于术后第3、6和12个月复诊时发现局部复发,接受二次手术治疗。本组病例术中、术后无严重并发症发生,全脊椎切除的6例患者截至最近随访时,未发现肿瘤复发,植骨融合,内固定稳定。结论：根据WBB分区系统完成的胸腰椎恶性肿瘤手术治疗策略,特别是全脊椎切除术是治疗恶性脊柱肿瘤的一种有效外科手段。     

脊椎血管瘤的外科治疗策略

[目的]探讨脊椎血管瘤的外科治疗策略。[方法]回顾1997年10月～2008年10月间的33例脊椎血管瘤。女19例,男14例;平均年龄54岁。13例患者因局部疼痛就诊;12例截瘫;8例存在神经根刺激症状和局部疼痛。9例患者为单纯局部疼痛,影像学无脊髓及神经根压迫,行经皮椎体成形术。24例患者存在硬膜囊或神经根压迫、软组织包块较大、或脊柱不稳,接受开放手术。其中,9例肿瘤主要侵犯椎体、伴有不同程度椎体压缩骨折或存在椎旁软组织包块,行前路手术治疗;12例肿瘤主要累及附件及椎体后缘,肿瘤突入椎管内压迫脊髓及神经根而无明显椎体压缩骨折,行后路手术,其中4例椎体内病灶较大,术中直视下行椎体成形术;3例肿瘤广泛累及椎体及附件,肿瘤侵入椎管内,椎体侧方存在软组织包块,行前后路联合手术。3例术前行节段动脉栓塞术。[结果]9例行单纯椎体成形的患者无围手术期并发症,平均随访41个月,疼痛均完全或明显缓解。开放手术的24例,无围手术期死亡患者。前路手术平均出血为2739ml,后路手术平均出血为1619ml(P=0.12)。1例腰椎前路手术患者术后出现椎体周围血肿并继发下肢静脉血栓。1例胸椎后路手术患者术后出现血肿后截瘫加重。1例腰椎后路手术患者出现伤口感染。19例患者开放手术前存在疼痛,手术后17例疼痛完全或明显缓解。12例截瘫患者的Frankel脊髓功能评分提高1～2级。行开放手术患者平均随访48个月。X线片示内固定物无移位、折断。1例死于其他肿瘤。影像学证实肿瘤复发或发展者4例,2例无症状给予观察,1例因疼痛行放疗,1例因截瘫再次手术。[结论]根据脊椎血管瘤患者症状产生的病因以及患者一般情况,应用多种相应外科技术治疗脊椎血管瘤,可以取得较好的临床效果。     

全脊椎整块切除术--一种治疗原发性恶性脊柱肿瘤的新手术方法

[目的]介绍一种整体切除脊柱原发性恶性肿瘤并使肿瘤治愈成为可能的新手术技术“全脊椎整块切除术”。背景资料：传统切除脊柱原发性恶性肿瘤的方法,是从肿瘤病灶内分块进行逐步切除。而经组织病理学证实,手术切缘较宽或较窄的病灶外整块切除的报告却鲜为有之。[方法]全脊椎整块切除术是在前路椎间支撑器植入,后路脊柱器械固定的情况下进行整块椎板切除和整块椎体切除的新手术技术。有5例息有原发性恶性肿瘤的患者及2侧患有巨细胞瘤的患者施行了这种手术。除l例患者在术后7个月时因肿瘤转移到纵隔而死亡外,其余所有患者的观察期为2～6．5a。[结果]除1例病人之外的所有患者在手术之后均获得了满意的临床效果,并且没有严重的并发症发生。经组织学研究证实,除椎弓根外,均获得了较宽或较窄的手术边缘,但在病变影响到椎管和脊柱的后方时,则需采用病灶内切除的传统方式。1例死于肿瘤转移的患者,其死亡原因与手术没有直接的相关性,且肿瘤切除的部位也没有局部复发的迹象。[结论]全脊椎整块切除术的优势在于,它是将整个椎体分两次予以完全切除,也就是一次切除椎体的一半,这种技术远胜于分块逐步切除的模式,并且是一次性完成整个手术的全过程。“全脊椎整块切除术”为脊柱原发性恶性肿瘤的治疗提供了一个更具有挑战性的手术方法。     

胸腰椎肿瘤全脊椎切除术后的稳定性重建及其并发症

目的 探讨胸腰椎肿瘤全脊椎切除术后与稳定性重建相关的并发症.方法 1997年1月至2009年12月接受全脊椎切除术且随访及存活时间超过18个月的胸腰椎肿瘤患者34例,男20例,女14例;年龄15～72岁,平均43岁.胸椎27例,腰椎7例.脊柱转移瘤6例,原发骨肿瘤28例.全脊椎分块切除23例,整块切除11例.后路椎弓根钉棒系统短节段固定19例,长节段固定13例,短节段前路固定2例.前方椎体重建采用钛网植骨20例,钛网骨水泥7例,骨水泥填塞2例,单纯植骨2例,带加强环的钛网植骨1例,人工椎体植骨2例;后方碎块植骨26例,大块桥接植骨8例.结果 随访18～128个月,平均43个月.7例死亡.4例原发肿瘤行分块切除者复发,1例行整块切除者复发.25例椎体间植骨者融合不良5例.术后患椎上、下椎体间矢状面Cobb角平均-6°(-34.2°～15.5°),末次随访或翻修术前9.3°(-17.5°～57.2°),丢失16.0°(1.2°~65.4°),后方多节段固定者丢失14.1°(0.8°～36.5°),短节段固定者丢失21.5°(4-4°～65.4°).内固定断裂5例、内固定松动2例,钛网下沉6例、移位3例.人工椎体置换病例无明显下沉和移位.2例行前后路翻修,2例更换断棒,1例更换螺钉.结论 全脊椎切除术后与脊柱稳定性重建相关的并发症较多.后方长节段经椎弓根固定配合大块桥接植骨、前方应用人工椎体置换与植骨可使脊柱获得坚强的临时固定与长期融合.

Abstract：

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.     

Total spondylectomy for primary malignant, aggressive benign, and solitary metastatic bone tumors of the thoracolumbar spine

The records of 14 patients with malignant or aggressive benign vertebral tumors of the thoracolumbar spine who underwent total spondylectomy (TS) were evaluated retrospectively. Total spondylectomy was performed by bisecting the affected vertebra through the pedicle using fine threadwire saws and removing the vertebra en bloc through the posterior procedure alone or the one-stage anteroposterior combined procedure. Remarkable pain relief and ambulation after surgery were achieved in all 14 patients. No serious complications occurred. Nerve roots were sacrificed in seven cases. A marginal surgical margin was achieved in 10 cases and an intralesional surgical margin was achieved in four. At the site of the osteotomized pedicle, the surgical margin was marginal, with the possibility of tumor-cell contamination in 10 cases. Local recurrence was found in three cases of posterior total spondylectomy at 0.3 to 3.5 years (mean, 3.2 years) follow-up evaluation at the other site of the osteotomized pedicle. These results suggest that this type of total spondylectomy is effective in controlling local recurrence without incurring major complications and is a clinically useful procedure.     

Biomechanical analysis of anterior versus circumferential spinal reconstruction for various anatomic stages of tumor lesions

STUDY DESIGN: Spinal reconstruction procedures for metastasis evaluated biomechanically using human cadaver specimens. OBJECTIVE: To investigate the stiffness of anterior versus circumferential spinal reconstructions for different anatomic stages of tumor lesions. SUMMARY OF BACKGROUND DATA: Metastatic tumors predominantly involve the vertebral bodies. Although anterior instrumentation and strut grafts provide excellent stability, it remains unclear to what extent vertebral destruction requires anterior reconstructions alone versus combined anterior and posterior procedures. METHODS: Ten human cadaveric thoracolumbar spines were used. The L1 vertebral body and posterior elements were resected sequentially based on Weinstein's anatomic zone classification for tumor lesions. Anterior reconstruction was performed between T12 and L2 using an iliac strut graft and the Kaneda SR system (AcroMed, Cleveland, OH). For circumferential reconstruction, the Cotrel-Dubousset hook and rod system was combined with the anterior reconstruction procedure. Experimental groups included the intact condition and five reconstruction stages: anterior reconstructions for corpectomy, subtotal and total spondylectomies, and circumferential reconstructions for subtotal and total spondylectomies. Nondestructive biomechanical testing was performed under four different loading modes. RESULTS: All the reconstruction groups except anterior instrumentation alone for total spondylectomy returned stiffness to a level equivalent or higher to that of the intact spine. There were no statistical differences observed between anterior and circumferential reconstruction for subtotal spondylectomy. Anterior instrumentation alone for total spondylectomy did not restore stiffness to the intact level, and demonstrated significantly lower stiffness than that of circumferential reconstruction. CONCLUSIONS: For corpectomy or subtotal spondylectomy, anterior reconstruction alone can provide stiffness equivalent to circumferential reconstruction. However, total spondylectomy significantly reduces the anterior reconstruction stiffness, suggesting the need for combined anterior and posterior procedures.     

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Wide surgical margins make en bloc spondylectomy and stabilization a referred treatment for certain tumoral lesions. With a total resection of a vertebra, the removal of the segment’s stabilizing structures is complete and the instrumentation guidelines derived from a thoracolumbar corpectomy may not apply. The influence of one or two adjacent segment instrumentation, adjunct anterior plate stabilization and vertebral body replacement (VBR) designs on post-implantational stability was investigated in an in-vitro en bloc spondylectomy model. Biomechanical in-vitro testing was performed in a six degrees of freedom spine simulator using six human thoracolumbar spinal specimens with an age at death of 64 (±20) years. Following en bloc spondylectomy eight stabilization techniques were performed using long and short posterior instrumentation, two VBR systems [(1) an expandable titanium cage; (2) a connected long carbon fiber reinforced composite VBR pedicle screw system)] and an adjunct anterior plate. Test-sequences were loaded with pure moments (±7.5 Nm) in the three planes of motion. Intersegmental motion was measured between Th12 and L2, using an ultrasound based analysis system. In flexion/extension, long posterior fixations showed significantly less range of motion (ROM) than the short posterior fixations. In axial rotation and extension, the ROM of short posterior fixation was equivalent or higher when compared to the intact state. There were only small, nonsignificant ROM differences between the long carbon fiber VBR and the expandable system. Antero-lateral plating stabilized short posterior fixations, but did not markedly effect long construct stability. Following thoracolumbar en bloc spondylectomy, it is the posterior fixation of more than one adjacent segment that determines stability. In contrast, short posterior fixation does not sufficiently restore stability, even with an antero-lateral plate. Expandable verses nonexpandable VBR system design does not markedly affect stability. The study was supported by corporate (coLigne AG, Zurich, Switzerland) and institutional funds.     

Modified total en bloc spondylectomy in thoracic vertebra tumour

Total en bloc spondylectomy (TES) for vertebral tumour was previously reported by Tomita through a single posterior approach using a T-saw. A modified total en bloc spondylectomy (MTES) technique is reported in the present study. The disc puncture needle with a sleeve was used to obliquely puncture from the posterior to the anterior direction. A T-saw was inserted through the sleeve and led out to the operator’s side by the leading clamp. The disc was partially cut with the saw from its medial to lateral aspect. After a spinal fixation rod was applied on the operator’s side, the residual discs on the opposite side were cut as described above. Six patients with thoracic vertebral tumours were operated on using the MTES technique. Five patients showed improvement in their neurological deficits postoperatively. There was no evidence of tumour recurrence at the final follow-up. The MTES is technically feasible with improved practicality and safety.     

Recurrent adamantinoma in the thoracolumbar spine successfully treated by three-level total en bloc spondylectomy by a single posterior approach

Purpose

Adamantinoma is a low-grade primary malignant bone tumour with slow growth and local recurrence. Its occurrence in the spine is extremely rare, particularly with multilevel involvement. This paper wants to present the first case involving a patient with recurrent thoracolumbar spinal adamantinoma, who underwent a successful three-level spondylectomy for en bloc resection.

Methods

A 24-year-old man with osteolytic masses of T11 and T12 vertebral bodies was performed curettage by a posterior approach in 2008. The pathology report showed the excised neoplasm was a rare adamantinoma. This patient underwent a tumorectomy again because of its local recurrence nearly 3 years later. In 2012, it was unfortunately revealed that the excised tumour had relapsed and had spread to the L1 vertebral body. Due to its repeated recurrence and aggressive lesion, total en bloc spondylectomy (TES) for this malignant tumour was thought to be the best option for preventing repeated recurrence and possible cure. TES for T11–L1 thoracolumbar spine was performed and spinal reconstruction was completed with instrumentation and a titanium mesh cage through a one-stage single posterior approach.

Results

After three-level TES, neurological deficits of the patient demonstrated good recovery and no evidence of adamantinoma recurrence or deformity was found at 2-year follow-up.

Conclusions

This is the first case involving multilevel thoracolumbar spinal adamantinoma with repeated recurrence to be successfully treated by three-level TES by a single posterior approach.

     

Thoracic vertebral body exostosis as a cause of myelopathy in a patient with hereditary multiple exostoses

The posterior thoracic vertebral body appears to be a novel origin for an exostosis causing myelopathy. A patient with hereditary multiple exostoses and myelopathy caused by an exostosis originating from the posterior aspect of the T5 vertebral body was treated with a staged anterior decompression/corpectomy and posterior spinal fusion. The patient had near-complete resolution of his myelopathy immediately after undergoing removal of the exostosis through a right-sided lateral thoracotomy approach. This was a unique origin for an exostosis causing spinal cord compression in a patient with hereditary multiple exostoses. The delivery of the exostosis was performed en bloc during the anterior decompression and corpectomy portion of the surgery. This resulted in the expected favorable outcome.     

脊柱原发软骨肉瘤的外科治疗

目的：探讨脊柱原发软骨肉瘤的治疗方法及预后。方法：对1993年-2005年收治的16例脊柱原发软骨肉瘤进行回顾性分析。男9例，女7例；年龄19—69岁，平均44岁。累及胸椎7例，腰椎2例，胸腰椎多发1例，骶椎6例。8例伴神经损伤症状，Frankel分级C级3例，D级5例。1例骶骨巨大软骨肉瘤因去分化改变采取化疗，因化疗无效患者放弃治疗出院；其余15例均行手术治疗，根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除术，并予以相应重建方式。结果：15例手术患者术后随访1—13年，平均6．2年。1例死于术后肺栓塞。术前有神经症状者中1例Frankel C级患者术后无改变，其余7例（87．5％）术后Frankel分级均改善1个等级。2例出现去分化改变，于术后12个月内死亡。术后复发7例，占47％（7／15），复发1次者4例（4／15，27％），复发2次以上者3例（3／15，20％）。除1例去分化软骨肉瘤外，其余6例每次复发后均行手术再次切除。至今存活12例，生存时间1-19年，平均7．5年。结论：对于脊柱原发软骨肉瘤，首选广泛性切除，对难以达到广泛切除者．应尽量争取彻底切除；对复发肿瘤，仍应争取再次手术并尽可能彻底切除，可达到一定的生存时间及功能保留。     

全脊椎整块切除治疗胸腰椎软骨肉瘤

 目的 探讨胸腰椎软骨肉瘤全脊椎整块切除的方法和临床疗效。方法 自2010年1月至2012年3月,对6例胸腰椎软骨肉瘤患者进行全脊椎整块切除术,男4例,女2例;年龄25～54岁,平均38岁。肿瘤分布于Ｌ3～Ｔ3脊椎,T3,4 1例、T7 1例、T11 1例、L1 1例、L2 1例、L3 1例。根据Tomita脊柱肿瘤外科分期进行评估,2型1例、4型1例、5型3例、6型1例。1例行单纯后路手术,5例行一期前路肿瘤分离、后路切除手术,所有患者均行椎弓根钉-棒系统内固定、椎体间植入钛网或人工椎体支撑植骨融合术。结果　平均术中失血量3200 ml(2100～6300 ml),手术时间3.5～12　ｈ(平均5.5　ｈ)。2例患者获得广泛性切除,3例为边缘性切除,1例为污染性切缘。术后脑脊液漏2例,胸腔积液需再次置管1例,肺部感染1例。无创口感染发生,无围手术期死亡。随访6～32个月,平均19个月,无肿瘤复发。手术前2例Frankel脊髓功能分级C级者术后恢复至E级。所有患者能无辅助下行走。所有患者均骨性融合,愈合时间为6～12个月,平均8个月。结论　全脊椎整块切除术是治疗胸腰椎软骨肉瘤的有效方法,可良好的控制肿瘤、改善神经功能。