Ⅰ期后路经椎弓根钉内固定联合骨水泥椎体重建术在治疗胸椎肿瘤中的应用

【目的】探讨Ⅰ期后路经椎弓根钉内固定联合骨水泥椎体重建术在治疗胸椎肿瘤中的方法及疗效。【方法】自2004年6月至2009年9月收治胸椎肿瘤患者9例，其中男5例，女4例，平均年龄49（34～67）岁；转移性腺瘤6例，原发性椎体肿瘤3例；T31例，T41例，T51例，T62例，T71例，T81例，T1 11例，T121例；Frankel分级B级1例，C级2例，D级2例，E级4例。均采用I期后路肿瘤椎体切除、经椎弓根钉内固定，同时联合骨水泥椎体重建术。术后摄X线片并观察患者神经恢复情况及肿瘤生长情况。【结果】随访8～16个月，平均13个月，所有患者局部疼痛和神经症状均有不同程度改善或缓解，术前VAS评分平均7分，术后平均3分，平均下降4分；术前脊髓神经功能有障碍者中1例由Frankel B级恢复至C级，1例由C级恢复至D级，其余均恢复至E级。所有患者至末次随访时存活，内固定未出现松动、断裂等现象，重建椎体无塌陷，肿瘤无局部复发。【结论】Ⅰ期后路肿瘤椎体切除，并予以经椎弓根钉内固定联合骨水泥椎体重建术是治疗胸椎肿瘤的一种有效手术方法，可改善脊髓神经功能，恢复脊柱稳定性，降低脊柱骨肿瘤局部复发率。

Application of One Stage Posterior Transpedicular Internal Fixation Combined with Bone Cement Vertebral Body Reconstruction in the Treatment of Thoracic Vertebral Tumor

Objective]To explore the technique and the effect of one stage posterior transpedicular internal fixation combined with bone cement vertebral body reconstruction for the treatment of thoracic vertebral tumor. Methods] Nine patients（5 male and 4 female, aged from 34-67 years with the average of 49 years） with thoracic vertebral tumor were selected between Jun. 2004 to Sep. 2009. Among all patients, there were 6 heteropodous ad enoma and 3 primary vertebral body tumor. The site of the tumors was at Ts in 1 case, T4 in 1 case, T5 in 1 case, T6 in 2 cases, T7 in 1 case, T8 in 1 case, T11 in 1 case and T12 in 1 case. Preoperative Frankel classification showed grade B in 1 case, grade C in 2 cases, grade D in 2 cases and grade E in 4 cases. All patients underwent one stage posterior vertebral body resection, transpedicular internal fixation and bone cement vertebral body reconstruction. After operation, x-ray film was performed, and the nervous function recovery and the growth of tumor were observed. Results] The follow-up period was from 8 to 16 months with the average of 13 months. The local pain and neurological symptoms of all patients were improved or relieved. The preoperative VAS score was 7 which decreased to 3 with the mean decrease of 4 points. The neurological function of 1 case in the patients who suffered from spinal nerve disorder recovered from Frankel B to E, and one case recovered from Frankel C to D and the rest recovered to Frankel E. All cases were found alive at final follow-up and no one had the incidence of internal fixation loosening and breaking, the collapse of reconstructed vertebral body and local tumor recurrence. Conclusion] One stage posterior vertebral body resection, transpedicular internal fixation and bone cement vertebral body reconstruction is a safe and effective method for the treatment of thoracic vertebral tumor. It can improve the spinal nerve function, recover the stability of spine and reduce the local recurrence of spinal cord tumor.