一期后路全脊椎整块切除术治疗胸椎肿瘤  

One stage total en bloc spondylectomy （TES） by posterior approach alone for thoracic vertebral tumors

作　　者：李锋[1] 方忠[1] 熊伟[1] 李光辉[1] 肖骏[1] 郭风劲[1] 陈安民[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《中华骨科杂志》2009年第8期705-710,共6页Chinese Journal of Orthopaedics

基　　金：国家“十一五”科技支撑计划资助项目（2007BAI-04807）

摘　　要：目的回顾性分析32例胸椎肿瘤手术治疗效果，探讨一期后路全脊椎整块切除术治疗胸椎肿瘤的可行性和疗效。方法2004年4月至2008年11月，32例胸椎肿瘤患者行一期后路全脊椎整块切除术。胸椎原发性肿瘤18例，胸椎转移瘤14例。肿瘤病灶均为单节段；原发良性肿瘤S23例，S36例，其中7例合并病理骨折；原发恶性肿瘤ⅠA4例，ⅠB3例，Ⅱ2例。14例转移性胸椎肿瘤按Tokuhashi预后评分系统均小于8分，且预计生存时间大于半年以上。所有病例按Frankel分级：A级2例，B级5例，C级8例，D级10例，E级7例（仅有局部疼痛）。结果手术时间为230-420min，平均270min；切除肿瘤时失血量为1200-4200ml，平均为2100ml。术后随访0．5-4．6年，平均3．2年。所有病例术后疼痛消失或减轻，术后3周时，VAS疼痛评分由术前平均8.3分下降至2．1分（P〈0．01）；术后生活质量改善明显，术后3周时SF-36评分由术前平均39分增加至79分（P〈0．01）。术后1年患者神经功能恢复正常24例，C级1例，D级2例（3例死亡和2例随访不足1年，未行神经功能评估）。至末次随访仅2例局部复发和8例死亡。结论一期后路全脊椎整块切除术治疗胸椎肿瘤安全可行。在严格掌握手术适应证条件下，能彻底切除胸椎肿瘤，对脊髓行360。彻底减压，缓解疼痛、促进脊髓神经功能恢复；还可有效控制术后肿瘤局部复发，延长患者生存时间和改善生存质量。Objective To investigate the surgical results of one stage total en bloc spondylectomy by posterior approach alone for thoracic vertebral tumors. Methods Total 32 patients with thoracic vertebral tumor treated with on stage TES by posterior approach from 2004 were reviewed. 18 cases suffered with the primary thoracic vertebral tumors, and 14 cases were diagnosed for the thoracic metastasis tumors including 5 cases of breast cancer, 4 cases of renal carcinoma, 3 case of thyroid cancer, 2 case of lung cancer. According to Ennekinng stage system, there were 3 eases for S2, 6 for S3, 4 for Ⅰ A, 3 for Ⅰ B, 2 for Ⅱ. And there were 2 cases for Grade A, 5 for Grade B, 8 for Grade C, 10 for Grade D,7 for Grade E according to Frankel grade system. Results The operation time is 270 min on average （230-420 min） and bleed loss is 2100 ml on average （1200-4200 ml） on the operation. The follow-up period lasted from 6 months to 3.2 years. All cases had got less pain after operation, and the VAS pain scores had attain 2.1 score from the 8.3 on the postperative time of 3 week. The SF-36 score increased from 39 to 79 on the postperative time of 3 week. In all cases with neurological deficit, they improved neurologically by more than one grade. Up to now, only 2 patients had be local recurrence after operation among the primary thoracic vertebral tumors and 8 patients had dead on the following time. The others still are alive and no local recurrence. Conclusion One-stage TES by posterior approach is feasible, safe and effective to thoracic vertebral tumor resection, which has many advantages such as controlling local recurrence, spinal cord decompression thoroughly, relieving the pain, improving the life quality and prolonging the lifetime.

关 键 词：胸椎 肿瘤 脊髓压迫症 脊柱融合术 

分 类 号：R686[医药卫生—骨科学]