后路一期全椎体切除加重建治疗脊柱肿瘤

目的 探讨脊柱肿瘤行后路一期全椎体切除加重建手术的可行性和临床意义.方法 应用后路一期全椎体切除加重建治疗26例脊柱肿瘤患者,其中巨细胞瘤5例,乳腺癌转移6例,肺癌转移8例,浆细胞瘤2例,肾癌转移3例,淋巴瘤2例.手术采用脊柱后正中切口,经椎弓根骨膜下切除椎体,用椎间融合器做前方重建,后方节段性固定,后外侧植骨融合.结果 患者全部完整随访,随访时间10～48个月.手术时间平均5.6 h,平均出血量2550 ml,4例患者术前局部后凸得到矫正.术前Frankel分级:D级11例,E级15例.术后Frankel分级全部为E级.局部疼痛7例减轻,19例消失.结论 后路一期全椎体切除加重建术是安全有效的手术方法 .可使神经充分减压,矫正后凸畸形,早期恢复负重,可提高脊柱肿瘤患者生活质量.

Single-stage posterior vertebrectomy with reconstruction in treatment of spinal tumor

Objective To investigate the feasibility and clinical significance of single-stage posterior vertebrectomy with reconstruction for the treatment of spinal tumor. Methods Twenty-six consecutive patients with spinal tumor, 5 with giant cell tumor, 6 with metastatic tumor of breast cancer, 8 with metastatic tumor of lung cancer, 2 with plasmacytoma, 3 with metastatic tumor of renal carcinoma, and 2 with lymphoma, 12 males and 14 females, aged 49 (20 - 74), underwent single-stage posterior vertebrectomy through bilateral transpedicular route via posterior miclline approach. Anterior column reconstruction was performed with non-expandable cages. Anterior and posterolateral arthrodeses were achieved using autograft. Posterior segmental instrumentation was used in all cases. Follow-up was conducted for 10 - 48 months. Results The mean operative time was 4.5 hours and the mean blood loss was 1600 ml. Sagittal deformity correction was performed for the four patients with preoperative kyphosis. 15 patients were neurologically intact preoperatively (at Frankel grade E) and remained intact postoperatively. 11 patients with functional disorders of spinal cord or nerves (Frankel grade D) preoperatively showed improvement to Frankel grade E postoperatively. Local pain disappeared in 19 patients and reduced in 7 patients. Conclusion A safe and effective technique for the treatment of spinal tumor, single-stage posterior vertebrectomy with reconstruction fully decompresses the neurological structures, corrects kyphosis, and achieves early weight-beating, thus significantly improving the quality of life of the patients with spinal tumor.