经后路全脊椎整块切除术在胸腰椎肿瘤中的应用

Spondylectomy en bloc for thoracic and lumbar tumors via posterior approach

目的探讨经后路全脊椎整块切除术(total en-bloc spondylectomy,TES)治疗脊椎肿瘤的方法与临床价值。方法我科2009年1月至2010年2月应用全脊椎整块切除术治疗脊柱肿瘤患者6例,其中男4性例,女性2例,年龄43～64岁,脊椎原发性恶性肿瘤2例,转移性脊柱肿瘤4例。病变发生在T112例,T121例,L42例,L51例。6例患者均采用单纯后侧入路,同时采用前方钛网植骨重建+椎弓根钉系统后方固定。结果 6例患者术中、术后无严重手术并发症,术后近期临床症状改善明显。随访12～24个月,均未出现局部复发,2例原发病例未出现远处转移。结论经后路脊柱肿瘤全脊椎整块切除术是治疗胸腰椎肿瘤的一种可行的手术方法,技术优势明显,能提高病灶切除率、降低局部复发率,近期随访疗效满意。

Objective To investigate the management and clinical effect of spondylectomy en bloc via posterior approach for thoracic and lumbar tumors.Methods Six cases（4 males and 2 females） with thoracolumbar spine tumor were treated with total en bloc spondylectomy in our department from Jan 2009 to Feb 2010.The group age was from 43 to 64 years old.There were 2 cases of primary malignant spinal tumor and 4 cases of metastatic spinal tumor.The site of tumors was 2 cases in T11,1 case in T12,2 cases in L4,and 1 cases in L5.All cases were operated through a simple posterior approach,and with the front titanium mesh cage and pedicle screw reconstruction＋rear fixed.All patients were followed up for 12 to 24 months.Results No severe complication was found in all patients during and after surgery.Postoperative clinical symptoms were improved significantly in short term.Two cases of primary cases had no distant metastasis found during the follow-up.Conclusion Total en bloc spondylectomy is a reliable treatment for thoracolumbar spine tumor,with obvious advantages,such as increasing the excision rate,decreasing the local recurrence rate,and satisfying follow-up results.