脊柱转移瘤的手术治疗

Operative treatment of metastatic tumors of spine

脊柱是转移瘤最常见的部位,脊柱转移瘤好发部位是腰椎,依次为胸椎与颈椎。但是,胸椎易发生脊髓损伤症状。手术治疗的目的是:解除神经压迫;通过稳定脊柱防止神经受损;减轻局部疼痛。当需行神经减压时,前路手术最直接,因为,椎体是转移瘤最常见的部位。单用椎板切除对改善神经功能是无效的,但是,联合应用内固定器械时,后路手术具有操作容易、创伤小和可矫正脊柱畸形的优点。如果行椎体全切前路骨性支撑时,应采用前后路联合术式。

The spine is the most common site of metastatic tumors. The highest incidence of metastatic tumors on the spine is in the lumbar region, followed by the thoracic and cervical levels. Most associated spinal cord lesions, however, are located in the thoracic spine. The goals of surgery is decompression of the neural tissues, prevention of neural injury by stabilization of the unstable spinal column, or pain control. When there is a need to decompress the neurologic tissues, the most direct ap- proach is anterior because the most common site of metastatic tumors is in the vertebral body. Laminectomy alone is not effec- tive in improving neurologic function. Nevertheless,the posterior approach is more accessible,less hazardous, and effective in the correction of deformity if combined with instrumentation. If complete vertebrectomy is feasible in anterior bone strut combined with anterior and posterior stabilization is necessary following the vertebrectomy.