颈胸段脊柱骨肿瘤术后再手术  

Reoperation for spinal tumors at the cervicothoracic junction

作　　者：杨兴海[1] 肖建如[1] 吴志鹏[1] 冯大鹏[1] 黄权[1] 郑伟[1] 陈华江[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：《中华骨科杂志》2010年第5期454-460,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈胸段脊柱骨肿瘤术后再手术的原因及其手术策略。方法2000年7月至2008年1月，对14例颈胸段脊柱骨肿瘤术后患者施行再手术。软骨肉瘤5例，骨巨细胞瘤5例，血管肉瘤、侵袭性骨母细胞瘤、副神经节瘤、动脉瘤样骨囊肿各1例。经前后联合入路行单个椎节切除6例、两个椎节切除2例、三个椎节3例，经后外侧入路行单个椎节切除1例、两个椎节切除2例。除2例三个椎节切除分二期进行外，其余均为一期完成。前路采用钛网或植骨、骨水泥加带锁钉板内固定系统或单棒内固定，后路采用钉棒内固定系统重建。术后血管肉瘤患者接受化疗和局部放疗，其余患者接受局部放疗。结果术后所有患者局部疼痛均有不同程度缓解，脊髓神经功能改善。3例脑脊液漏，经引流、换药处理后愈合，2例Homer综合征和1例声音嘶哑于术后2-5周自行恢复。随访18-108个月，平均45个月。7例患者分别于术后12-22个月再次复发，其中5例分别于术后30-38个月瘫痪、死亡，2例带瘤生存。结论颈胸段脊柱骨肿瘤术后再手术的主要原因是肿瘤局部复发或肿瘤残存。复发与肿瘤病理类型、切除方式和相关综合治疗的衔接有关。应该珍惜第一次手术机会，力争将肉眼可见的肿瘤彻底切除。与初次手术相比，再手术具有更高的风险及难度，术者应熟悉颈胸段脊柱的解剖结构。Objective To investigate the causes and operative technique of reoperation for spinal tumors at cervicothoracic junction. Methods The records of 14 consecutive patients underwent reoperation between July 2000 and January 2008 were retrospectively studied. Pathological types included chondrosarcoma in 5 cases, giant cell tumor in 5, and hemangiosarcoma, invasive osteoblastoma, chromaffinoma, aneurysreal bone cyst in 1 case, respectively. There were mono-segment spondylectomy in 6 cases, di-segments in 2 and tri-segments in 3 cases. Eleven patients underwent tumor resection through combined anterior and posterior approach, while 1 case had mono-segment spondylectomy and 2 cases had di-segments spondylectomy through a posterolateral approach. Tumor resections had accomplished in one stage for all cases except that 2 cases of tri-segments spondylectomy were performed in two-stage. Anterior reconstruction was achieved by titanium mesh filled with bone graft or bone cement plus locking screw-plate system or single rod fixation while screw-rod system was used for posterior reconstruction. The patient with hemangiosarcoma accepted chemotherapy and local radiotherapy, while other patients received local radiotherapy as adjuvant therapy after reoperation. Results Local pain relieved and neurofunction improved in all patients in various degrees. Postoperative complications included leakage of cerebral spinal fluid in 3 cases healed by drainage and dressing, Homer syndrome in 2 cases and transient hoarse voice in 1 case recovered 2 to 5 weeks after operation. All patients were followed up from 18 months to 9 years. Seven cases developed local recurrence 12 to 22 months after reoperation. Among them, 5 cases died 30-38 months after reoperation while 2 cases were alive with tumor lesion. Conclusion The influencing factor of local recurrence includes pathological type of tumor, resection fashion and relative adjuvant therapy. Operative rationale and resection fashion are crucial for surgical therapy. The opportunity of first op

关 键 词：颈椎 胸椎 骨肿瘤 再手术 

分 类 号：R687.3[医药卫生—骨科学]