严格掌握原发性脊柱肿瘤全脊椎整块切除的适应证

The indications of total en bloc spondylectomy for primary spinal tumors should be strictly mastered

原发性脊柱肿瘤相对少见，约占所有脊柱肿瘤的20%，全身骨肿瘤的6. 6%～8. 8%[1]。尽管原发性脊柱肿瘤的诊治原则与四肢骨肿瘤基本相同，但由于脊柱解剖复杂，毗邻脊髓神经、大血管及重要脏器结构，其外科切除难度较大、风险较高，既往多采用次全切除方式，局部复发率居高不下，治疗效果远不如四肢骨肿瘤。近20年来，随着脊柱外科技术的不断进步、脊柱内固定与重建器械的飞速发展及肿瘤学认识的逐步融入，脊柱肿瘤的治疗由过去的简单椎板切除、减压到现在的全脊椎切除，由过去的分块切除到现在的整块切除，使得脊柱肿瘤的临床疗效明显提高。

Primary spinal tumors are relatively rare. Because of its anatomical complexity, adjacency to the spinal nerves, great vessels and vital organs and high degree of difficulty and risk of surgical resection, the therapeutic effects of primary spinal tumors are unsatisfactory. Currently, surgical resection is still the most basic and important clinical treatment method for primary spinal tumors. The musculoskeletal tumor staging system developed by Enneking et al. has been generally accepted in the surgical treatment of musculoskeletal tumors. According to this staging system, the resection approach and extension are determined by the biological behavior of tumors. In 1997, the Weinstein-Boriani-Biagini （ WBB ） staging system was published. After that, a relatively uniform standard was proposed in the international academic exchange and comparison related to spinal tumors, which was designed to take the overall resection into account with the spinal cord reserved. According to the Enneking and WBB staging systems, total vertebral resection should be performed in the treatment of primary malignant tumors of the spine and some invasive benign tumors, so as to achieve the aim of removing the tumors within the compartment. The posterior total en bloc spondylectomy （ TES ） technique developed by Tomita et al. for thoracolumbar spinal tumors is the most important means of acquiring reasonable surgical margins, with the advantages of short operation time, less blood loss, minimal surgical trauma, low complication rate and so on. However, the TES technique can only control the recurrence of tumors. If abused, there will be more trauma and complications. Therefore, the operation indications should be strictly mastered in accordance with the treatment concept of spinal tumors. The personalized and accurate design and implementation of resection margins of spinal tumors and the optimization and application of adjuvant therapy will be the subjects needing joint efforts in the ifeld of spinal tumors in the future.