脊柱活动节段脊索瘤的外科治疗及其预后(附15例报告)  

Surgical treatments and outcomes of the chordoma in the mobile spine:15 cases review

作　　者：杨墨松[1] 马俊明[1] 杨诚[1] 谢宁[1] 杨兴海[1] 冯大鹏[1] 黄权[1] 肖建如[1] 袁文[1] 贾连顺[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中国矫形外科杂志》2008年第3期175-178,共4页Orthopedic Journal of China

摘　　要：[目的]探讨脊柱活动节段脊索瘤外科治疗方式与疗效。[方法]对接受手术治疗的15例脊柱活动节段脊索瘤病人的临床资料进行回顾性分析。根据肿瘤WBB(Weinstein-Boriani-Biagini)分期,肿瘤主要位于椎体范围内,即4~9扇区内7例,累及椎体且超过一侧4扇区或9扇区4例,同时超过两侧4扇区和9扇区4例;肿瘤侵及A^D层13例,A^C层2例;单椎节骨质破坏9例,2个椎节骨质破坏5例,累及3个椎节1例。手术行椎体或矢状切除10例,全脊椎切除5例。后路重建4例(4例病灶均位于上颈椎),前路重建3例,前后联合重建8例。术中取大块自体骨(髂骨或肋骨)或钛网+植骨块融合9例,钛网+骨水泥填塞支撑6例。术后均辅以瘤灶局部放疗。[结果]患者术后临床症状改善明显,神经功能恢复满意,植骨融合率100%。随访14~123个月,平均56.2个月,局部复发7例,死亡4例,未见远处转移病例。[结论]脊柱活动节段脊索瘤临床发病较少,早期症状不典型。应注重肿瘤的早期诊断与治疗。手术切除是治疗脊柱脊索瘤的主要手段,全脊椎切除能明显降低复发率。术后辅助以肿瘤病灶局部放疗对抑制肿瘤复发或进展有积极作用。[ Objective] To investigate the surgical treatments and outcomes of chordomas in the mobile spine. [ Methods ] A series of 15 cases of chordomas arising from the mobile spine which received surgical treatments were retrospectively reviewed. According to the WBB （Weinstein-Boriani-Biagini） surgical staging system, the tumours mainly occupied the vertebral body areas, ic, 4 to 9 radiating zones in 7 cases, expanded outside to 4 or 9 radiating zone in 4 cases, both to 4 and 9 radiating zones in 4 cases. Thirteen of them affected A to D layers, the other 2 affected A to C layers. One vertebra was involved in 9 cases, two vertebrae were involved in 5 cases and 3 vertebrae in 1 case. Vertebrectomies or sagittal resections were performed in 10 cases and total spondylectomies in 5 cases. Four patients underwent posterior approach operations and 3 patients underwent anterior approach operations for spinal reconstruction and stabilization. Eight patients received combined anterior and posterior operations for spinal reconstruction and stabilization. Tricortical autogenions bone grafts, some in titanium mesh, were used for reconstruction in 9 patients. While mesh and bone cement were uesd in 6 patients. Local radiation therapies were performed in all patients after surgeries. [ Results] Clinical symptoms and neurologie deficits were relived in all the patients. Fusion of the bone grafts was got in all the 9 eases. The follow-up was 14 to 123 months, average 56.2 months. Local-recurrence could be observed in 7 eases and 4 eases died. No metastasis was seen in this series. [ Conclusion ] Eearly diagnosis and treatment have great effects on the prognosis of the ehordoma arising in mobile spine. Total spondyleetomy with postoperative radiation therapy can decline the local-recurrent rate.

关 键 词：脊柱活动节段 脊索瘤 外科治疗 

分 类 号：R738.1[医药卫生—肿瘤]