脊柱肿瘤切除及功能重建

RESECTION OF SPINAL TUMOR AND RECONSTRUCTION OF SPINAL STABILITY

目的 应用不同的脊柱固定方法探讨脊柱肿瘤切除后的功能重建。方法15 例脊柱肿瘤切除术中应用前路肿瘤切除及固定13 例,前后路联合切除及后路固定2 例,其中Kaneda 固定器加骨水泥及植骨10 例;克氏针骨水泥固定3 例;Steffee 钢板加骨水泥及植骨各1例。结果 术后1 周11 例能支撑坐起,2 周9例在保护下可下地行走,3个月时13例恢复行走功能;术后2 个月12 例疼痛消失,2 例减轻;术后1 例因骨髓抑制死亡。4 例转移癌分别在术后3 个月～1 年死亡,随访3～20 个月效果满意。结论 脊柱肿瘤切除后应用骨水泥或植骨加内固定物可使脊柱早期恢复负重功能,减轻疼痛,利于神经功能的恢复,而采用前路术式以Kaneda 固定器。

Objective Both primary and metastatic tumor of spine can influence spinal stabitity, spinal cord and nerves.The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. Methods Since Aug. 1993 to Oct. 1996,15 cases with spinal tumor were treated,including 4 primary spinal tumor and 11 metastatic tumor.Tumor foci were mainly in thoracic and lumbar spine.Graded by Frankel classification of spinal injuries ,there were 1 case of grade A,1 of grade B,3 of grade C,5 of grade D and 5 of grade E.Tumors of upper lumbar spine and thoracic spine were resected through anterior approach.Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two staged operation:firstly,operation through posterior approach to reconstruct spinal stability; secondly, operation through anterior approach.After resection of tumor,the spines were fixed by Kaneda instrument,Steffee plate or Kirschner pins. To fuse the spine,bone grafting was used in benign tumor and bone cement used in maligant tumor. Results Except one patient died from arrest of bone marrow,the others were followed up for 3 to 20 months.Postoperatively,11 patients could sit up on one foot with the help of body supportor,and 9 patients could walk in two weeks under careful monitoring.There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved:1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E.Conclusion The spine can be reconstructed for weight bearing early by internal fixation.The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.