改良后路Ⅰ期全脊柱整块切除脊柱重建术治疗侵袭性胸椎血管瘤  

Clinical study of modified one stage posterior approach total en block spondylectomy and spinal reconstruction in the treatment of invasive thoracic vascular tumor

作　　者：王增平[1] 刘林[1] 薛文[1] 宋玉鑫[1] 钱耀文[1] WANG Zeng-ping;LIU Lin;XUE Wen;SONG Yu-xin;QIAN Yao-wen(The Second Department of Orthopaedics,Gansu Provincial People’s Hospital,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃省人民医院骨二科,甘肃兰州730000

出　　处：《中国骨伤》2021年第8期759-763,共5页China Journal of Orthopaedics and Traumatology

基　　金：甘肃省科技支撑计划项目(编号:1204FKCA113);甘肃省卫生厅管理项目(编号:GWGL201410);甘肃省人民医院院内重大研发攻关项目(编号:17GSSY3-3)。

摘　　要：目的:探究改良后路Ⅰ期全脊柱整块切除椎弓根螺钉固定联合钛网椎体重建治疗侵袭性胸椎血管瘤的手术方法及其安全性。方法:对2012年12月至2015年5月收治的12例侵袭性胸椎血管瘤患者进行回顾性分析,其中男8例,女4例;年龄40~62岁,平均51.2岁;病程2个月~8年,平均3.4年。病变累及椎体:T_(2)1例,T_(4)4例,T_(5)1例,T_(6)2例,T_(8)2例,T_(10)2例。Tomita分型:Ⅰ型3例,Ⅱ型3例,Ⅲ型1例,Ⅳ型5例。术前日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分为8.0±2.7,1例T_(10)病变者脐以下感觉运动障碍,双下肢肌力Ⅰ-Ⅱ级,其余11例患者双下肢肌力Ⅲ-Ⅳ级。12例患者均在全麻下行后路Ⅰ期全脊柱整块切除椎弓根螺钉固定联合钛网椎体重建术,手术全程持续运动诱发电位(motor evoked potential,MEP)脊髓电生理监测。对手术时间、术中出血量、输血量、术后局部疼痛和脊髓功能恢复情况以及钛网植骨融合、肿瘤复发及随访期其他并发症进行随访观察。结果:所有患者顺利完成手术,平均手术时间、术中出血量、输血量依次为5.5 h(4.5~6.0 h)、1850 ml(1650~2500 ml)、1050 ml(600~1500 ml)。12例患者均获得随访,时间5个月~2.5年,平均21个月。局部疼痛和双下肢肌力均得到不同程度的恢复,神经压迫症状均消失。术后6个月JOA评分为12.0±3.4,与术前的8.0±2.7相比,差异有统计学意义(t=3.20,P<0.05)。钛网植骨全部Ⅰ期融合,平均融合时间为4.5个月(3~7个月)。随访期间未见肿瘤复发、钉子松动或断裂及钛网下沉及移位。结论:改良后路Ⅰ期全脊柱整块切除术是一种比较理想的治疗侵袭性胸椎血管瘤的手术方法,具有安全、可靠、持久的疗效。Objective:To explore the surgical method and safety of modified one stage posterior approach total en block spondylectomy combined with pedicle screw fixation and titanium mesh reconstruction for the treatment of invasive thoracic vascular tumor.Methods:The clinical data of 12 patients with invasive thoracic vasculay tumor from December 2012 to May 2015 was retrospectively analyzed.There were 8 males and 4 females,aged from 40 to 62 years with an average of 51.2 years,the course of disease was 2 months to 8 years with an average of 3.4 years.The lesions involved vertebral bodies:1 case of T_(2),4 cases of T_(4),1 case of T_(5),2 cases of T_(6),2 cases of T_(8),and 2 cases of T_(10).According to Tomita classification,there were 3 cases of typeⅠ,3 cases of typeⅡ,1 case of typeⅢ,and 5 cases of typeⅣ.The Japanese Orthopaedic Association(JOA)score was 8.0±2.7 before operation.One patient with T10 lesions had sensory dyskinesia below the umbilicus,and the muscle strength of both lower limbs was gradeⅠ-Ⅱ,and the others 11 patients were gradeⅢ-Ⅳ.All 12 patients underwent one stage posterior approach total en block spondylectomy and the pedicle screw fixation combined with titanium mesh reconstruction under general anesthesia and continuous motor evoked potential(MEP)spinal cord electrophysiological monitoring throughout the operation.The operation time,intraoperative blood loss and transfusion,postoperative pain and recovery of spinal cord function,bone graft fusion,tumor recurrence and other complications were followed up.Results:All the operations were successful.The average operation time,intraoperative blood loss and blood transfusion were 5.5 h(4.5 to 6.0 h),1850 ml(1650 to 2500 ml),1050 ml(600 to 1500 ml),respectively.All 12 patients were followed up for 5 months to 2.5 years with an average of 21 months.Local pain and lower limb muscle strength were improved to varying,and the nerve compression symptoms disappeared.The JOA score at 6 months after operation was 12.0±3.4,which was statistically sig

关 键 词：血管瘤 胸椎 脊柱重建 外科手术 

分 类 号：R639[医药卫生—外科学] R529.2[医药卫生—临床医学]