单一后路三节段全脊椎切除治疗脊柱恶性肿瘤  

Three-level En Bloc Spondylectomy through a single posterior approach for malignant spinal tumors

作　　者：范宏斌 付军 薛英森 郭征 王臻 Hong-bin;FU Jun;XUE Ying-sen;GUO Zheng;WANG Zhen(Department of Orthopaedic Surgery,Xi-Jing Hospital,the fourth Military Medical University,Xi'an,Shaanxi,710032,China)

机构地区：[1]空军军医大学附属西京医院骨科,西安710032 [2]西北妇女儿童医院骨科,西安710061

出　　处：《中国骨与关节杂志》2019年第1期15-20,共6页Chinese Journal of Bone and Joint

基　　金：国家重点研发计划(2016YFB1101104);陕西省重点项目-社会发展领域(2018ZDXM-SF-075)

摘　　要：目的全脊椎切除术(total en bloc spondylectomy,TES)可显著降低术后脊柱恶性肿瘤的局部复发率,三节段TES较单节段更为复杂。本研究探讨了单一后路三节段TES治疗脊柱恶性肿瘤的手术技巧及中短期随访结果。方法回顾性分析了2010～2012年,在我科接受单一后路三节段TES的5例患者,包括乳腺癌脊柱转移2例,肾透明细胞癌脊柱转移1例,脊柱原发上皮样血管内皮瘤1例,脊柱原发间叶软骨肉瘤1例,病变节段分布于T4～11之间。按照Tomita外科分型均属于第6型,脊髓损伤中Frankel C级4例,Frankel D级1例。Tomita评分平均为3.4分。Karnofsky功能状态评分平均为48%。脊柱不稳定性SINS平均得分13分。术前除1例间叶软骨肉瘤患者外均接受了肿瘤滋养血管栓塞手术,所有患者均成功实施了三节段TES。结果平均手术时间6.8 h,平均失血量6260 ml。术中结扎双侧三对根动脉和神经根后脊髓监护未发生明显改变,术后患者亦未发生明显功能障碍。5例30～62个月(平均45个月)随访。随访期间1例局部复发,进行了二次减压手术,目前带瘤生存;1例死于肺转移;其余3例均为无瘤生存。患者VAS疼痛评分从术前平均7.8 (7～9)分降至术后平均1.6 (1～2)分;脊髓损伤Frankel评分从术前4例C级,1例D级术后均恢复至E级。所有标本术后病理证实均达到切缘阴性。结论本研究证明,在严格掌握手术适应证和熟练掌握手术技巧的情况下,三节段TES治疗脊柱恶性肿瘤仍可以取得令人满意的结果。Objective Total En Bloc Spondylectomy(TES)is widely used to avoid local recurrence in the treatment of spinal malignant tumors.Three-level EBS are aggressive procedures associated with complications and morbidity.This study aims to report the surgical technique and results of tumor control after 3-level TES for spinal tumors.Methods We conducted a retrospective study of 5 patients treated with 3-level TES between 2010 and 2012.Surgical data were noted.Radiographs,magnetic resonance images,and computed tomographic scans were studied for local recurrence,graft,and instrumentation failures at subsequent follow-up.There were 5 malignant tumors:2 metastatic breast cancer,1 metastatic kidney clear cell carcinoma,1 chondrosarcoma,1 epithelioid haemangioendothelioma.All patients belonged to Tomita’s Type 6.The mean score of Tomita grading system and Karnofsky performance were 3.4 and 48%,respectively.Four patients with spinal injury were classified into Frankel C and 1 into Frankel D.All patients received pre-operative arterial embolization expect one with chondrosarcoma.Results The mean surgical time was 6.8 h and estimated blood loss was 6260 ml.The mean follow-up was 45 months(range:30-62 months).At the last follow-up,3 patients were alive with no evidence of diseases,1 alive with pulmonary metastasis,and 1 dead of diseases.Only 1 patient had local recurrence.Five patients with Frankel C and D had full neurological recovery.Histopathological assessment of specimen showed the margins were free of tumor.The mean VAS score decreased from 7.8 to 1.6 after operation.Conclusions 3-level TES can be offered to patients to prevent local recurrence.With strict surgical indication and skillful surgical technique,it is proven to be beneficial.

关 键 词：脊柱 恶性肿瘤 全脊椎切除 

分 类 号：R738.1[医药卫生—肿瘤]