一期经后路全脊椎整块切除治疗胸椎肿瘤18例临床疗效分析

One stage total en bloc spondylectomy for thoracic tumor treatment via posterior approach:clinical efficacy analysis on 18 cases

目的探讨一期经后路全脊椎整块切除（total en bloc spondylectomy，TES）治疗胸椎肿瘤的临床疗效。方法2010年1月至2012年10月，我院所行一期经后路TES治疗的胸椎肿瘤患者18例，包括男性11例，女性7例，年龄18-64岁，平均43．7岁；胸椎原发肿瘤5例，转移瘤13例（术前已作原发瘤切除）；肿瘤病灶连续双节段者2例，其余均为单节段病灶；Tomita分期为Ⅳ期11例，V期7例；术前神经功能按Frankel分级：A级0例，B级4例，C级2例，D级7例，E级5例。分别观察术前，术后1、3、6、12个月和末次随访时VAS评分、SF-36评分情况。结果手术时间235-420min，平均280min；术中出血1000-3400mL，平均2300mL；本组病例术后疼痛症状均明显缓解或消失，VAS疼痛评分由术前（8．5±0．2）分降至术后1个月（2．6±0．4）分，两者差异有统计学意义（P〈0．05）；术后生存质量改善明显，sF．36评分由术前（43±9）分增加至术后6个月（81±8）分（P〈0．05）；术后3个月，患者神经功能按Frankel分级恢复正常者12例，c级4例，D级2例。结论在严格掌握手术适应证的情况下，一期后路TES治疗胸椎肿瘤能够彻底减压脊髓，改善神经功能，显著缓解患者疼痛，提高生存质量，延长恶性肿瘤患者生存时间，并可有效减少肿瘤局部复发。

Objective To explore the clinical outcome of one stage total en bloc spondylectomy （TES） for thoracic tumor treatment through posterior approach. Methods From January 2010 to October 2012, 18 patients undertaken one stage TES for thoracic tumor treatment through posterior approach in our hospital were enrolled in this study. There were 11 males and 7 females, aged 18 -64 years, with mean age of 43. ？ years. Five cases of primary thoracic tumor and 13 eases of metastatic tumor were included. Double seg- mental consecutive tumor lesions were found in 2 cases and the rest had single segmental lesions. According to Tomita stage system, there were 11 cases of stage 1V and 7 cases of stage V. Neurological function in all patients included, according to Frankel grade, 0 case of A grade, 4 cases of B grade, 2 cases of C grade, 7 cases of D grade and 5 cases of E grade. The ~AS scores and SF-36 scale were recorded at the time of pre-operation, 4 weeks, 3 months, 6 months and 12 months after the operation, and the last follow-up, respectively. Results All the operations had operative time of 235 -420 rain （average 280 min） and blood loss 1 000-3 400 mL （average 2 300 mL）. All the patients reported significantly alleviated or disappeared pain in 4 weeks after operation. VAS pain score was significant reduced from 8.5 ± 0.2 before operation to 2.6 ＋ 0.4 in 4 weeks after operation （P 〈 0. 05 ）. Postoperative quality of life was improved significantly. Six months after operation, SF-36 score improved from an average of 43 ± 9 points before operation to an average of 81 ± 8 points （ P 〈 0.05）. Three months after operation, neurological function assessed by Frankel grade returned to normal in 12 cases, C grade in 4 cases, and D grade in 2 cases. Conclusion A posterior TES can complete resect thoracic spinal cord tumor, decompress the spinal tumor, improve nerve function, prolong survival time, relieve pain significantly, and reduce local recurrence effectively.