胸椎单脊椎原发性肿瘤后路全脊椎切除的临床疗效

The clinical result of posterior total-vertebrectomy and spinal stability reconstruction for single-level primary thoracic tumors

目的 观察胸椎单脊椎原发性肿瘤后路一期病椎切除，单纯植骨融合、填充自体骨钛网或填充骨水泥钛网支撑，后路椎弓根钉系统内固定的临床疗效。方法1997年2月～2005年4月对26例胸椎单脊椎原发性肿瘤患者实施后路一期病椎切除、脊髓减压，同时对良性、低度恶性肿瘤进行前路单纯植骨融合、填充自体骨钛网支撑，高度恶性肿瘤采用骨水泥钛网支撑，所有患者实施后路植骨，应用椎弓根钉系统内固定重建脊柱稳定性。本组男15例。女11例，平均年龄22岁（14～52岁）。其中，动脉瘤样骨囊肿5例，骨囊肿2例，血管瘤5例，骨髓瘤3例，嗜酸性白细胞肉芽肿2例，骨巨细胞瘤6例，骨肉瘤3例。术前Frankel分级：A级2例，B级8例，C级7例，D级3例，E级6例。结果术后随访时间6个月～8年。术前疼痛24例，术后无疼痛22例（91．7％），疼痛减轻2例，疼痛缓解率95．8％。20例脊髓功能障碍者，14例完全恢复，5例部分恢复，1例无恢复，脊髓功能改善率95％。6例患者出现8个术中和术后并发症，并发症发生率38．4％。结论胸段单脊椎原发性肿瘤后路一期全脊椎切除术安全可行，可有效控制肿瘤的局部复发、缓解疼痛、提高生活质量、延长寿命．临床疗效满意。

Objective To evaluate the clinical result of posterior total-vertebrectomy and spinal stability reconstruction for single-level primary thoracic tumors. Methods Twenty-six patients （15 males and 11 females） of single-level primary thoracic tumors accepted posterior total-vertebrectomy and spinal stability reconstruction from February 1997 to April 2005. The mean age was 22 （ range from 14 to 52）. There were 5 aneurysmal bone cysts, 2 bone cysts, 5 hemangiomas, 3 myelomas, 2 eosinophilic granulomas, 6 giant cell tumors and 3 osteosarcomas. The spinal reconstruction was obtained by only autograft or titanium mesh filled with autograft for benign and low-grade malignant tumors and methyl methacrylate-filled titanium mesh for high-grade malignant tumors. The spinal stability was enhanced by posterior internal fixation with rod-screw system. There were 2 of Grade A, 8 of Grade B, 7 of Grade C, 3 of Grade D and 6 of Grade E according to Frankel grade system before operation. Results The follow-up period .lasted from 6 months to 8 years. Twenty-four cases had pain before operation, among which 22 cases obtained complete relief（91.7% ）and 2 cases obtained partly relief after operation. The improvement rate of pain was 95.8%. In 20 cases with neurological deficit, 14 cases recovered completely, 5 cases recovered partly and 1 case obtained no recovery. The recovery rate was 95%. The complication appeared in 6 cases （38.4%）. Conclusion Posterior total-vertebrectomy for single-level primary thoracic tumors is feasible, safe and effective to tumor resection and stability reconstruction, which has many advantages such as controlling recurrence, prolonging the lifetime, relieving the pain and improving the life quality. The clinical result is satisfactory.