一期后路全脊椎切除治疗胸腰椎转移性肿瘤  

One Stage Enbloc Spondylectomy for Thoracolumbar Spinal Metastatic Tumor Treatment Via Posterior Approach

作　　者：张志才[1] 邵增务[1] 杨述华[1] 吴强[1] 刘建湘[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022

出　　处：《实用骨科杂志》2016年第6期493-495,506,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨一期后路全脊椎切除治疗胸腰椎转移性肿瘤的临床疗效。方法 2004年6月至2014年12月,我院行一期后路全脊椎切除治疗胸腰椎转移性肿瘤患者24例,男15例,女9例;年龄41～72岁,平均65.2岁;累及胸椎10例,腰椎14例,均为单节段病灶。术前神经功能Frankel分级：B级2例,C级6例,D级10例,E级6例。观察手术时间、术中出血量和临床治疗效果等。结果手术时间平均3.5～5.4 h,平均4.2 h;术中出血量2 000～4 500mL,平均3 200 mL。术后脊髓神经功能Frankel分级均获得改善或保持原有水平,差异有统计学意义（P〈0.05）,术后随访6～96个月,平均62.8个月,随访期间死亡8例,平均生存时间为45.3个月（11～72个月）;其他16例患者存活,随访中无内固定失效。结论一期后路全脊椎切除治疗胸腰椎转移性肿瘤具有手术时间短、出血比较少、住院时间短等优点,但需严格掌握其手术适应证,且对术者要求较高。Objective To investigate the clinical outcome of one stage en bloc spondylectomy for thoracolumbar spinal metastatic tumor treatment via posterior approach. Methods From June 2004 to December 2014,24 patients with thoracolumbar spinal metastatic tumor underwent one stage en bloc spondylectomy via posterior approach. There were 15 males and 9 females,aged 41 ～ 72 years,with mean age of 65. 2 years. 10 cases of thoracic tumor and 14 cases of lumbar tumor were included,and all of them had single segment lesions. According to Frankel grade,there were 2 cases of B grade,6 cases of C grade,10 cases of D grade and 6 cases of E grade. The surgical time,amount of intraoperative blood loss,Frankel grade of each patient were recorded. Results The average operation time was 4. 2 hours（ range,3. 5 ～ 5. 4 hours）,the average blood loss was 3200 mL（ range,2 000 ～ 4 500 mL）. The neurofuction of the patients had improved or kept level before in Frankel grade after operation（ P〈0. 05）. The cases were followed up from 6 to 96 months（ average,62. 8 months）. There were 8 cases died during the follow-up,and the average live time was 45. 3 months（ range,11 ～ 72 months）. The other 16 cases were survival and no internal fixation failure. Conclusion One stage en bloc spondylectomy for thoracolumbar spinal metastatic tumor treatment via posterior approach is reliable,and has good qualities such as short operation time,small blood loss and short length of stay. But the operation indication should be controlled strictly,and it needs a good technique team.

关 键 词：全脊椎切除 脊柱 转移性肿瘤 后路 

分 类 号：R783.1[医药卫生—口腔医学]