肿瘤椎体切除人工椎体置换脊柱重建术

Prosthetic vertebra replacement for spinal reconstruction after resection of tumorous vertebra

目的 探讨肿瘤椎体切除人工椎体置换脊柱重建的有关问题。方法 分析 5例手术治疗的临床资料 ;复习国内文献资料。结果 5例术后 6～ 12个月重建椎体骨性融合 ,其中 1例前列腺癌术后 2 6个月死于肺转移。国内文献 32例 ,1例术后 3天死于心衰和肺部感染 ;31例重建椎体骨性融合 ,其中 3例螺钉松动。结论 肿瘤椎体切除 ,采用人工椎体置换可重建脊柱支撑 ;不管椎体肿瘤是原发还是转移 ,凡能耐受手术者均应尽早手术 ;假体内外植骨才能牢固融合 ;术前节段性椎动脉栓塞 ,术中采用控制性低血压 。

Objective To explore some aspects concerning the removal of tumorous vertebra and prosthetic replacement for spinal reconstruction. Methods Analysis of clinical data of 5 cases and review of domestic documentation. Results All 5 cases obtained spinal fusion 6～12 months after operation. Among them, one case of postatic carcinoma died from pulmornary metastasis 26 months after operation. Among domestic documentation of 32 cases except for one patient died of heart failure and lung infection, the other 31 cases were followed up for different time span and achieved spinal fusion, screw of 3 cases loosened. Conclusion After radical resection of the tumor, the insertion of a prosthetic vertebral can reestablish spinal stability. Either primary or metastatic vertebra tumors, all patients should receive operation as soon as possible when physical condition allowed. Bone grafting within and around the prosthetic vertebra can provide osseous spinal stability. Preoperative vertebra arterial embolization and keeping low blood pressure during operation can reduce bleeding.