腰椎肿瘤的外科治疗19例分析

Surgical Treatment of Lumber Vertebra Tumors:Analysis of 19 Cases

目的 探讨腰椎肿瘤术前经椎弓根和经皮穿刺活检的方法，评价其作用，并探讨个性化手术切除肿瘤及重建的外科治疗方法。方法 对19例腰椎肿瘤的患者均采用在CT引导下经椎弓根和经皮穿刺活检的方法获得病理诊断，并结合WBB分期制定外科治疗方案，肿瘤切除后采用钛笼或髂骨重建缺损并以Z-plate固定。结果 19例患者经穿刺活检有18例获得阳性结果，无并发症发生。外科治疗术后疼痛症状均有减轻或消失，随访2～36个月，仅有1例因肿瘤复发发生Z-plate松动。随访期间所有病例无内固定物断裂，未发现高度丢失现象。结论 在CT引导下经椎弓根和经皮穿刺活检是腰椎肿瘤术前确诊的有效方法，前路切除后行钛笼重建和Z-plate固定是理想的外科干预方法。

Objective To observe the efficacy of the percutaneous or transpedicular puncture biopsy of lumber vertebra tumors under CT guidance and to evaluate the personality ways of tumors excision and reconstruction. Methods 19 patients with lumber vertebra tumors were reported. They were diagnosed under CT guidance percutaneous or transpedicular puncture biopsy. Surgical treatment strategy combined with preoperative WBB staging assessment. After the respectability of tumors, titan cage or iliac bone was used for reconstruction and Z-plate were used as fixation system. Results 19 cases were performed biopsy, of which 18 cases got pathologic results and 1 failed, and no complication occurred in this group. After surgical treatment, the lumber pain and related leg pain were disappeared or relieved. All patients were followed up for 2～36 months. There was instability of Z-plate in only one case. no internal fixation breakage and height lose was found during follow-up period. Conclusion It is an effective and reliable way to perform percutaneous or transpedicular puncture biopsy under CT guidance in diagnosis of lumber vertebra tumors. After the respectability of tumors , titan cage and Z-plate system were an ideal way for reconstruction.