后入路脊椎整块切除+经椎弓根内固定重建脊椎稳定性治疗胸椎肿瘤  

Using the posterior spinal-wide en bloc excision,transpedicular fixation and reconstruction of spine stability to treat the thoracic spine tumors

作　　者：王宏亮[1] 干阜生[1] 曹杰[1] 于海洋[1] 董磊[1] 

机构地区：[1]阜阳市人民医院骨科,安徽阜阳236004

出　　处：《临床骨科杂志》2010年第3期256-259,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨后入路全脊椎整块切除环脊髓360°减压+经椎弓根内固定重建脊椎稳定性治疗胸椎肿瘤的可行性及临床效果。方法采用后入路全脊椎整块切除、环脊髓360°减压、经椎弓根内固定、重建脊椎稳定性治疗8例胸椎、胸腰段肿瘤患者,病变节段为T4～12,所有手术均一期1个入路彻底清除病灶、脊髓减压、内固定并重建脊椎即刻稳定性。结果手术时间为260～460(330±110)min,出血量为1200～3500(2180±870)ml。8例均获随访,时间12～18个月。X线及MR检查显示减压较彻底,脊椎即刻稳定良好,随访期内无内固定松动、断裂。神经功能均有明显恢复。结论后入路全脊椎整块切除、环脊髓360°减压、经椎弓根内固定、重建脊椎稳定性治疗胸椎、胸腰段肿瘤可以做到良好的椎管减压和能较彻底地切除病灶,降低创伤和肿瘤播散机会。Objective To study the feasibility and clinical effects of en bloc resection of the whole spine,360° spinal cord decompression,pedicle fixation and reconstruction of spinal stability in the treatment of thoracic spine tumors.Methods There were eight cases of thoracolumbar tumor were undergone posterior approach,en bloc resection of the whole spine,360° spinal cord decompression,pedicle fixation and reconstruction of spinal stability involving T4~12.All operations were performed through a single surgical approach,and removing lesions completely,spinal cord decompression,internal fixation and reconstruction of the spine instantly stability were achieved at one time.Results The operation time was 260~460 min and the average was（330±110）min.The blood loss was 1 200~3 500 ml and the average was（2 180±870）ml.All patients were followed up for 12～18 months.The X-ray and MRI demonstrated that the decompression was thoroughly,the vertebrae were stabilized instantly,and the internal fixation had no displacement and fragmentation within follow-up phase.The function of nerves all had obvious recovery.Conclusions Using the posterior approach spine-wide en bloc resection,360° spinal cord decompression,pedicle fixation and reconstruction of thoracic spine stability,the vertebral canal can be decompressed better,the lesions can be removed more thoroughly and the opportunities for trauma and tumor spreading reduced.

关 键 词：后入路 全脊椎整块切除 脊柱肿瘤/外科学 

分 类 号：R738.1[医药卫生—肿瘤] R687.3[医药卫生—临床医学]