经后路全脊椎切除术在胸腰椎肿瘤治疗中的应用

目的:探讨经后路全脊椎切除、自体骨移植与内固定治疗胸腰段脊柱肿瘤的可行性和临床疗效.方法:对2007年6月~2010年8月间11例胸腰段脊柱肿瘤患者采取经后路全脊椎切除、自体骨移植与钉棒内固定术,其中肋骨移植6例、自体髂骨移植2例、骨水泥重建3例.按 Tomita分型,1型2例,2型2例,4型6例,5型1例.Frankel分级术前 A级1例,B级1例,C级2例,D级4例,E级3例.结果:手术时间150~380min,平均270min,出血量400ml~4000ml,平均2230ml.术后随访9~48个月.3例死亡,其中1例肾母细胞瘤 T4转移,术后5个月与死于肺转移呼吸衰竭;1例肺癌 T9转移,同时局部复发于术后8个月死于呼吸衰竭;1例肝癌 L1转移,术后6个月死于上消化道大出血.其余未见复发.本次随访时 Frankel分级 C级3例,D级4例,E级4例.结论:按照 Tomita分型选择适合的胸腰段脊柱肿瘤,采用单一后路全脊椎切除、自体骨移植与钉棒内固定重建,能获得创伤小、并发症少,疗效可靠的临床效果.

Appfication of Total En Bloc Spondylectomy for Thoracolumbar Tumors via Posterior Approach

Objective：To investigate the feasibility and clinical effect of the total en bloc spondylecto- my, strut bone grafting and internal fixation via posterior approach for thoracolumbar tumors. Methods：l 1 ca- ses from June 2007 to August 2010 with bone tumors involving thoracolumbar were operated by the total en bloc spondylectomy, strut bone grafting and nail -rod fixation, among which 6 cases with rib grafting, 2 case with ilium grafting, 3 cases with bone cement reconstruction. According to Frankel grading system, there were 1 case of level A, 1 case of level B, 2 cases of level C, 4 cases of level D and 3 cases of level E preoperatively. Resuits：The operative time was 150 -380 rain, and the average operative time was 270 min, the blood loss was 400 - 4 000 ml, the mean loss was 2230ml. During 9 - 48 months postoperative follow - up, one case died of respiratory failure with pulmonary metastasis after 5 months, who was operated because of Wilms tumor in T4 metastasis, one case died of respiratory failure with local relapse after 8 months, who was operated because of lung cancer in T9 metastasis, one case died of massive hemorrhage of upper digestive tract, the others had no relapse. In the final follow - up, there were 3 cases of level C, 4 cases of level D and 4 cases of level E. Conclusions ： The clinical effects of little hurt, fewer complications and good curative effects can be obtained by the total en bloc spondylectomy, strut bone grafting and internal fixation via posterior approach alone for thoraco- lumbar tumors which are chosen correctively according to Tomita grading system.