单纯后路全脊椎整块切除术治疗L5椎体肿瘤  

The application and insight of single-stage posterior total en bloc spondylectomy treatment on L5 vertebrae spine tumors

作　　者：刘玉杰 万维 万炯熙 张杰 王达 刘繁荣 杨兴海 肖建如 Liu Yujie;Wan Wei;Wan Jiongxi;Zhang Jie;Wang Da;Liu Fanrong;Yang Xinghai;Xiao Jianru(Department of Orthopaedic Oncology,Changzheng Hospital,Naval Medical University,Shanghai 200001,China)

机构地区：[1]海军军医大学长征医院骨肿瘤科,上海200001

出　　处：《中华骨科杂志》2022年第24期1615-1622,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82172964);上海市科委项目(19411962700,18411964400)。

摘　　要：目的探讨L5椎体肿瘤行单纯后路全脊椎整块切除术的可行性及手术技术要点,分析该技术的有效性及安全性并在此基础上提出L5椎体肿瘤的综合治疗模式。方法回顾性分析2014年1月至2021年9月采用单纯后路全脊椎整块切除术(total en bloc spondylectomy,TES)治疗的13例L5椎体肿瘤患者资料,男4例、女9例;年龄(33.85±14.24)岁(范围21~65岁)。术前全脊柱X线片及腰椎CT均提示为无转移灶的L5椎体原发性肿瘤或L5椎体孤立性转移瘤。所有患者均采用单纯后路TES术治疗,通过调整腰椎前凸曲度,充分游离腰神经根,从而整块切除病椎,并利用脊柱椎弓根钉棒系统行腰椎稳定性重建。观察指标包括手术时间、术中出血量、并发症、手术前后腰椎前凸角度、日本骨科协会评估治疗分数(Japanese Orthopaedic Association scores,JOAs)及肿瘤转归。结果术前穿刺活检病理诊断为原发性骨肿瘤12例,孤立性转移瘤1例;其中骨巨细胞瘤7例,侵袭性血管瘤、上皮样血管瘤、动脉瘤样骨囊肿、良性脊索细胞肿瘤、孤立性浆细胞骨髓瘤及乳腺癌骨转移各1例。手术时间(333.23±99.48)min(范围175~480 min),术中出血量(1407.69±676.49)ml(范围300~2800ml),无一例出现严重围手术期并发症。随访时间(54.92±19.29)个月(范围28~84个月),JOAs由术前(13.85±3.86)分改善至术后6个月(24.31±2.16)分,差异有统计学意义(t=8.19,P<0.001)。术后2例出现切口延迟愈合;2例出现左下肢麻木症状,1例足背伸肌力减弱,均于术后3个月内明显缓解。结论单纯后路整块切除术治疗L5椎体原发性良性侵袭性肿瘤或孤立性转移瘤,不仅可减少手术创伤,且术后并发症较少,最终可获得良好的功能及肿瘤学预后。Objective To investigate the feasibility and technical points of single posterior total spine resection for L5 vertebrae tumors,evaluate the effectiveness and safety of the technique,and propose a comprehensive treatment model for L5 tumors on this basis.Methods A retrospective analysis was performed on the data of 13 patients with L5 vertebrae tumor who were treated by total en bloc spondylectomy(TES)through single-stage posterior approach from January 2014 to September 2021,including 4 males and 9 females.The age range was 21-65 years,with an average age of 33.85±14.24 years.Imaging examination showed isolated tumors of L5 vertebrae without other metastases.All patients were treated with a single posterior L5 vertebrae tumor TES by adjusting the curvature of lumbar lordosis,and the lumbar nerve root was fully dissociated.The vertebra with tumor was removed entirely and lumbar stability reconstruction via a pedicle screw system.Various parameters,including operative time,blood loss,complications,preoperative and postoperative spine sagittal parameters,Japanese Orthopaedic Association scores(JOAs),tumor control and outcome,were listed and analyzed.Results Preoperative pathological diagnosis of 13 patients was mainly primary bone tumor including giant cell tumor in 7 cases,and invasive hemangioma,epithelioid hemangioma,aneurysmal bone cyst,chordoma,plasma cell myeloma and bone metastasis of breast cancer in 1 case.The mean operative time was 333.23±99.48 min(range 175-480 min),and the mean intraoperative blood loss was 1407.69±676.49 ml(range 300-2800 ml).There were no serious perioperative complications during the perioperative period.The mean follow-up was 54.92±19.29 months(range 28-84 months).JOAs improved from 13.85±3.86 points before operation to 24.31±2.16 points at 6 months after operation,and the difference was statistically significant(t=8.19,P<0.001).Postoperative delayed wound healing occurred in 2 case.2 patients showed numbness of the left lower limb,and 1 patient had slightly reduced plantar f

关 键 词：腰椎 脊椎肿瘤 脊柱前凸 治疗结果 

分 类 号：R738.1[医药卫生—肿瘤]