全脊椎整块切除术治疗原发性腰椎肿瘤九例

目的探讨全脊椎整块切除术（TES）在治疗原发性腰椎肿瘤中的可行性及疗效。方法2005年6月至2009年7月共使用TES治疗原发性腰椎肿瘤患者9例。行单一后路全脊椎切除7例（L1骨肉瘤和和骨巨细胞瘤各1例，12骨巨细胞瘤、单发浆细胞瘤、软骨肉瘤和脊索瘤各1例，L3组织细胞肉瘤1例）；行后前联合入路全脊椎切除2例（L4骨巨细胞瘤并椎旁巨大肿块和纤维肉瘤各1例），肿瘤切除后均一期进行脊柱重建。对所有病例进行术前、术后神经功能测评及肿瘤复发情况的追踪。结果所有患者术后均获得随访，随访时间3～49个月，平均19个月。所有患者术后临床症状均明显改善，未出现严重手术并发症。近中期随访未发现肿瘤的局部复发及远处转移。结论对于原发性腰椎肿瘤，行TES加脊柱重建术，方法可靠，近中期随访效果满意，长期结果有待进一步随访。

Total en bloc spondylectomy for 9 patients with primary tumor of the lumbar spine

Objective To evaluate the possibility and curative effect of total en bloc spondylectomy (TES) for the treatment of primary tumors of the lumbar spine. Methods Between June 2005 and July 2009,nine cases of primary tumor of the lumbar spine were treated with total en bloc spondylectomy through a single posterior approach performed in seven cases(L1 giant cell tumor, L1 osteosarcoma, L2 giant cell tumor,L2 solitary plasmacytoma, L2 chondrosarcoma, L2 chordoma, and L3 histiocytic sarcoma), and two cases through a single stage anterior and posterior combined approach (L4 giant cell tumor with paraspinal mass and L4 fibrosarcoma). They were performed a single stage reconstruction after removing tumors of vertebra. Neurofunction was evaluated perioperatively and recurrence of tumor was tracked for all cases.Results The follow up was obtained for 3-49 months (averaging 19 months). All patients attained significant clinical improvement after surgery without any severe complications. There was no local recurrence and distal metastasis in shortterm follow-up. Conclusion The treatment by TES to remove tumors and reconstruction of spine are reliable for primary tumors of the lumbar spine. The curative effect of short-term follow-up is satisfactory. However, the long-term curative effect remain to be further follow-up.