椎管内外沟通肿瘤手术中脊柱稳定性的重建

Reconstruction of spinal stability for intra - and extra - spinal tumor in operation

目的探讨椎管内外沟通肿瘤术中脊柱稳定性的保留及重建。方法回顾性分析26例椎管内外沟通肿瘤患者的临床资料，16例术前骨质受肿瘤严重侵蚀，10例骨质受肿瘤侵蚀轻微或未侵蚀，但术中需要打开椎间孔切除肿瘤。20例采取半椎板＋受累椎间孔后壁切除，6例采取全椎板＋受累椎间孔后壁切除。23例采取单纯后正中入路，3例采取前后联合入路。除C3-7行侧块螺钉植入，其余椎体行椎弓根螺钉植入固定。结果所有患者术后3周内戴外固定支具下地活动，术后3个月～1年复查，未见内固定物脱落及断裂现象，无脊柱滑脱、后凸及侧弯畸形。结论椎管内外沟通肿瘤手术过程中，不管术前已经影响到脊柱的稳定性，还是术中由于打开椎间孔影响到脊柱稳定性，均需要行内固定。

Objective To investigate the preservation and reconstruction of spinal stability for intro- and extra - spinal tumor in operations. Methods Clinical data of 26 patients with intra - and extra - spinal tumor were retrospectively studied. The bone was destroyed by tumor severely in 16 patients, the bone was not destroyed by tumor or destroyed not so severely in 10 patients, but the faeetectomy was needed for the removal of tumor. Hemilaminectomy and faeetectomy was performed in 20 cases, and laminectomy and facetectomy was performed in 6 cases. The tumor was excised through the posterior approach in 23 patients, and through the posterior approach combined with the anterior approach in 3 patients. The pedicular screw fixation was perfomled in all the vertebral body except cervical 3 to 7 in which the lateral mass screw fixation was performed. Results All patients began exercising with the support of a simple external brace within 3 weeks postoperatively, there was no displacement or fracture of the instrumentation of internal fixation, and no spinal spondylolisthesis and deformity were observed. Conclusions The spinal stability was destroyed in operation because of faeeteetomy and laminectomy; sometimes, the spinal stability can be destroyed by the tumor because of bone erosion pre - operatively. Internal fixation should be performed for the reconstruction of spinal stability.