后路器械内固定在上胸椎肿瘤手术中的应用  

Posterior spinal instrumentation in proximal thoracic tumors

作　　者：陆宁[1] 王岩[1] 肖嵩华[1] 刘郑生[1] 张永刚[1] 王征[1] 张雪松[1] 

机构地区：[1]解放军总医院骨科医院,北京100853

出　　处：《脊柱外科杂志》2007年第2期80-84,共5页Journal of Spinal Surgery

摘　　要：目的：本文是一项病例回顾性研究，旨在了解后路器械内固定在上胸椎（T1-5）肿瘤手术治疗中的作用和意义，及其对上胸椎肿瘤手术策略的影响。方法：对我科2002年2月～2005年12月间接受了后路器械内固定的7例上胸椎肿瘤患者进行随访，比较患者手术前后疼痛、神经功能分级和放射影像学结果。结果：有2例患者实现了病椎的全椎大块切除（total en bloc spondylectomy，TES），2例患者通过瘤内切除技术（intralesional resection）达到病椎的完全切除（total vertebrectomy，TV），3例患者完成了病椎的部分切除（partial vertebrectomy，PV）。有3例患者接受后路颈胸椎联合固定，3例患者接受了椎体成形术。在末次随访时所有的患者均存活，至末次随访的最短随访时间为8个月，最长随访时间36个月（平均15．8个月）。所有患者术前均有中到重度的疼痛，术后疼痛完全缓解。采用改良A-SIA评分标准进行神经功能评分，术前有4例患者截瘫（1例为B级，3例为C级），术后全部恢复至E级。没有出现任何与内固定器械有关的神经和血管损伤。结论：使用后路器械内固定可保证脊柱术后即时的稳定性，因此不仅能进行椎板切除，还能单纯经后路完成病椎的完全或部分切除，达到彻底的脊髓减压，有助于实施TES或实现TV。对多节段病变、颈胸结合部病变及病理性骨折导致的脊柱后凸畸形的手术治疗具有重要的意义。Objective This is a retrospective study to investigate the functions and meanings of posterior spinal instrumentation in the operation for proximal thoracic tumors, and the affections in surgical strategy. Methods Between February 2002 and December 2005, 7 patients underwent surgery for proximal thoracic tumors with posterior spinal at our institution. Clinical and radiologic follow-up assessment were available for all the patients. Preoperative pain, neurologic grade, radiologic evaluation, and outcome measures were analyzed. The patients＇satisfaction rate was investigated as well. Results There were 2 patients achieved total en bloc spondylectomy. Two total vertebrectomies and 3 partial vertebrectomies were performed with intralesional resection. Posterior cervicothoracic instrumentation was used in 3 patients, and vertebroplasty was combined in 3 patients, who accepted PV. All the patients were alive till the last follow-up. The shortest follow-up was 8 months, the longest was 36 months （average 15.8 months）. All the patients had moderate to severe pain before operation, and the complete pain release was achieve after operation. Neurologic status was graded on modified ASIA scale, paralxa, esis, was present in 4 patients （ grade B = 1 case, grade C = 3cases） before operation, the postoperative ASIA grades were all grade E at the last follow-up. No neurologic complications or vertebral artery injury occurred related to screw insertion. All the patients were very satisfied with the results. Conclusion Posterior spinal instrumentation can rebuild the spinal stability immediately after operation, so not only palliative laminectomy but also total or partial vertebrectomy though posterior-only approach can be performed to get complete spinal cord decompression, and make it possible to fulfill TES or TA. The posterior instrumentation was also meaningful to some of the situations, such as multiple-level involvement, cervicothoracic junction invoulvement, and the associated kyphotic abnormality with pathologi

关 键 词：脊椎肿瘤 截骨术 内固定器 

分 类 号：R687.43[医药卫生—骨科学]