经升主动脉和头臂干右侧间隙切除T_3和T_4椎体肿瘤  

Anterior thoracic corpectomy for upper thoracic spine T_3,T_4 tumors by the right space of the ascending aorta and the right space of the brachiocephalic artery

作　　者：詹新立[1] 肖增明[1] 宫德峰[1] 陈前芬[1] 罗高斌[1] 

机构地区：[1]广西医科大学第一附属医院脊柱骨病科,南宁530021

出　　处：《中华骨科杂志》2006年第12期808-812,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨经升主动脉右侧间隙与头臂干右侧间隙行椎体切除治疗上胸椎T3、T4肿瘤的术式及疗效。方法2000年6月至2006年1月共治疗上胸椎肿瘤患者12例,男7例,女5例;年龄29～60岁,平均42岁。原发性肿瘤8例,转移瘤4例。T3肿瘤4例,T4肿瘤6例,T3,4肿瘤2例。采用改良的经胸骨柄入路,经升主动脉右侧间隙和头臂干右侧间隙显露椎体肿瘤病灶。采用刮除方式切除肿瘤3例(巨细胞瘤1例,嗜酸性肉芽肿1例,动脉瘤样骨囊肿1例),余采用整块切除方式切除。椎体间采用自体髂骨或骨水泥进行重建,颈椎前路带锁钛钢板内固定。脊髓损伤程度按Frankel分级标准评定。结果术中发生血压下降和(或)气道阻力增加6例。术后随访4～66个月,平均28.6个月。12例患者术后神经功能均有改善。3例植骨患者植骨均融合。1例T3骨肉瘤患者和3例转移瘤患者术后10￣18个月因全身多处转移,衰竭死亡。1例巨细胞瘤患者采用刮除方式切除后10个月局部复发。结论经升主动脉右侧间隙和头臂干右侧间隙行T3、T4椎体切除重建内固定术可获得良好的暴露,近期疗效满意,适用于脊髓前方存在压迫的上胸椎T3、T4椎体肿瘤。Objective To investigate the procedure of anterior thoracic corpectomy and the surgical outcomes of upper thoracic spine tumors by the right space of the ascending aorta and the right space of the brachiocephalic artery. Methods 12 patients underwent surgery between June 2000 and January 2006. There were 8 cases of primary tumors and 4 metastatic carcinomas, 4 cases of tumor in T3 and 6 cases in T4 and 3 cases in T3,4. The anterior modified transmanubrium approach was made. After the exposure of the tu- mor through the right space of the ascending aorta and the right space of the brachiocephalic artery, the involved vertebral body and contiguous discs were resected, the spinal cord was decompressed. Curettage was performed in 3 cases for other tumors, en bloc vertebrectomies were performed. As a body replacement, in case of benign disease autogenous bone graft harvested from the dorsal iliac crest was used, and for malignant bone tumors using bone cement. To secure the strut, anterior cervical titanium alloy plates were used until T3. Neurological status was graded according to Frankel grading system. Results 6 cases of bradycardia and hypotension or increasing airway resistance occurred intraoperatively. The mean follow-up period was 28.6 months （range 4-66 months）. 3 patients with autogenous bone graft had bone union 6 months postoperatively. According to Frankel grading system, 1 patient improved from grade A preoperation to B postoperation, while another patient from B to C; of the 5 cases with grade C preoperation, 4 patients improved to D postoperation and 1 patient to E; 4 patients improved from D to E; 1 patient with grade E left unchanged. 3 patients died from general metastasis and failure 10-20 months postoperatively. One patient with giant cell tumor recurred 10 months postoperatively. Conclusion Clear exposure and satisfactory outcome can be obtained by the use of the right space of the ascending aorta and the right space of the brachiocephalic artery; it is especially indicated to the upper thor

关 键 词：胸椎 肿瘤 主动脉 

分 类 号：R738.1[医药卫生—肿瘤]