后外侧入路全脊椎切除重建术治疗胸椎骨肿瘤

目的探讨胸椎骨肿瘤后外侧入路全脊椎切除方式、重建技术及其疗效。方法25例胸椎骨肿瘤患者实施后外侧入路全脊椎切除重建术。经胸椎后外侧入路行单椎节切除22例、双椎节切除3例,均采用Harms钛网植骨/钛网骨水泥联合TSRH/MOSS/CDHM8椎弓根钉内固定系统重建。结果随访3个月~6年,23例术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解;21例脊髓神经功能完全恢复;1例术后出现一过性瘫痪加重;3例分别于术后1~3年局部复发;术后12和18个月各死亡1例。结论胸椎后外侧入路全脊椎切除能显著降低胸椎骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。钛网植骨/钛网骨水泥联合椎弓根螺钉系统能有效重建脊柱的前后柱稳定,同时具有减少创伤、缩短手术时间、降低并发症的优势。

Total spondylectomy and reconstruction for bone tumors of thoracic spine by posterolateral approach

Objective To investigate the effect of total spondylectomy and stability reconstruction through posterolateral approach on treatment of thoracic spinal tumors. Methods 25 consecutive cases with bone tumors of thoracic spine who underwent total spondylectomy and stability reconstruction through posterolateral approach were evaluated retrospectively, One and two segments total spondylectomy were perfomed by posterolateral approach successfully on 22 cases and 3 cases respectively, Titanium mesh filled by lilac bone block or bone cement combined with posterior pedicle screw system as TSRH/MOSS/CDH M8 were used to reconstruct stability of spine, Results The following up period was from 3 months to 6 years. The recent effects after operation were satisfactory in 23 cases,with complete recovery of spinal cord function in 21 cases. 1 case developed a transient progression of lower limbs palsy; I case with malignant fibrous histiocytoma; 1 case with chordoma and 1 case with aneurysmal bone cyst occurred local recurrence in l -3 years postoperation. 1 case with poorly differentiated metastatic adenocarcinoma from unknown origin and 1 case with metastasis from hepatoma died of multiple metastasis and system failure in 12 and 18 months postoperation respectively. Conclusions Posterolateral approach to total spondylectomy and reconstruction for bone tumor of thoracic spine contributes to decreasing local recurrence, improving function of spinal cord and enhancing operative effect, Titanium mesh filled by lilac bone block or bone cement combined with posterior pedicle screw system provides effective and strong stability reconstruction of both anterior and posterior columns of spine. Posterolateral approach presents advantages on decreasing trauma, shortening operative time and reducing complications.