同体位一期前后联合入路脊柱肿瘤切除术

One-stage combined anteroposterior approches for spinal tumors in one position

目的 探讨在侧卧位下一期完成前、后入路胸腰段和腰段全脊椎肿瘤整块切除术的可行性。方法2004年12月至2006年9月，对累及椎体和附件的18例全脊椎肿瘤患者采用同体位一期前后联合入路肿瘤切除术。男12例，女6例；年龄34-65岁，平均48岁。原发性脊柱肿瘤6例，脊柱转移瘤12例；肿瘤部位：T12 3例，L12例，L24例，L35例，L43例，k1例。根据Tomita脊柱肿瘤分型系统：3型3例，4型8例，5型7例。结果1例L4椎体病变偏右并有椎旁软组织肿块，故在前侧采用右侧入路；1例L5肿瘤在前侧采用脐下腹部横切口；其余患者前侧从左侧斜行入路。15例达到椎体整块切除，2例转移瘤椎体部分较局限而行椎体大部分切除，1例L4软骨肉瘤病椎侧壁有少量残留，术后10个月出现肿瘤局部复发。所有患者的后侧椎弓根螺钉位置无误，前侧椎间钛网位置良好。手术时间240-480min，平均320min。手术失血量1200～5600ml，平均2600ml。随访6个月～2年，平均12个月。2例骨转移瘤者分别在术后6个月和8个月死亡。1例尤文肉瘤术后1年出现多发远处转移而死亡。1例甲状腺癌骨转移者术后5个月出现右侧转子间病理性骨折而行人工关节置换术。结论同体位一期前后联合入路可避免术中因体位翻动的二次消毒，缩短手术时间，避免二期手术。此入路具有更好显露、切除病变的优点，可同时完成前、后路的重建和固定，获得良好的脊柱稳定性。

Objective To analyze the surgical exposure and the spinal reconstruction after removal of the spinal tumors, so that the radical resection of the spinal tumors and the reconstruction of the spine can he performed. Methods A retrospective review was performed for surgical treatment of spinal tumors from December 2004 to September 2006. All of the 18 patients were treated with one-stage combined anteroposterior surgery. There were 12 males and 6 females, with average 48 years old （ranging from 34 to 65 years）. The tumors involved： the primary spinal tumors in 6 cases, solitary metastases in 12 cases. Tumors were distributed in the thoracic （n=3） and lumbar （n=15） spine. The Tomita system： 3 type 3 cases, 4 type 8 cases, 5 type 7 cases. Results One patient whose tumor appeared in the right lateral of affected vertebrae under- went right and anterior approach. And one patient with L5 tumor underwent anterior approach which the nick was under the umbilicus. The other 16 patients underwent left and anterior approach. The en bloc resections were performed in 15 patients and the bulk resections were performed in 2 patients with metastases of the spine. One patient with chondrosarcoma in L4 recurred 10 months after surgery. During follow-up, all anterior reconstruction and posterior instrumentation were stable and no evident reconstnlction loss; pseudoarthrosis or implant failure was noted. The duration of surgery was from 240 to 480 min （average, 320 min）. The blood loss was from 1200 to 5600 ml （average, 2600 ml）. All patients were followed-up for 6 months to 2 years（average, 12 months）. One patient with Ewing sarcoma died of metastasis that was not directly related to surgery itself. One patient with thyroid metastasis underwent total hip replacement because an intertrochanteric pathologic fracture occurred 5 months after surgery. Conclusion One-stage combined anteroposterior surgery for spinal tumors can he accomplished in a lateral position. The technique can provide adequate exposure and radical resection of the affected vertebrae. One-stage combined anteroposterior surgery in a lateral position may have a significant value in the treatment of spinal tumors.