原发脊柱肿瘤的外科分区与手术治疗

Surgical Staging and Management of Primary Spine Tumors

目的 探讨原发脊柱肿瘤外科分区 ,提高手术疗效。方法 本组共 15例 ,男 8例 ,女 7例。年龄 9～ 5 9岁 ,病程平均 5 5个月。其中良性肿瘤 7例 ,恶性肿瘤 8例。手术方法有 :(1)全脊椎切除 5例 ,(2 )椎体切除 7例 ,(3)矢状扇形半脊椎切除 2例 ,(4)椎体附件扇形切除 1例。 8例患者使用脊柱前路或后路内固定重建脊柱稳定性。结果 全部患者术后局部疼痛和放射痛缓解 ,肌力改善 ,有坚强内固定者术后 2周在支具 (石膏 )保护下离床活动。 7例良性肿瘤平均随访 4 5年 ,均无局部复发、恶变与转移现象 ,8例恶性肿瘤平均随访3 4年 ,1例于术后 1年死亡 ,1例骨髓瘤患者术后半年局部复发 ,截瘫症状加重 ,行二次减压手术。结论 根据WBB脊柱肿瘤外科分区而提出的手术计划是一个积极的探索 ,本组结果表明脊柱肿瘤切除较彻底 ,复发率低 ,近中期疗效良好。

Objective To improve the management and to evaluate the outcome of primary spine tumors. Methods Totally, there were 15 cases in this series, 8 males and 7 females. Ages were from 9 to 59 years, the means was 37 years. 7 cases were benign tumors and the remaining 8 cases were malignant tumors. A new spine tumor classification system (Weinstein Boriani Biagini, WBB) was applied in this study based on pre CT and MRI images. Four surgical procedures were applied to en bloc excision of spine tumors. They were (1) vertebrectomy in 4 cases, (2) corporectomy in 7 cases, (3) sagittal resection in 2 cases and (4) posterior arch resection in 1 case. Stabilization was achieved by bone graft and anterior or posterior instrumentation in all cases. Results All patients had a pain relieve, motor function was improved in 12 patient. Average length of follow up period was 4.5 years in benign tumor group, no recurrence was observed in all patients. The mean follow up time was 3.4 years in malignant group, 5 patients were absence of local recurrence and metastasis, one patient died of complication one year later, the remaining one had recurrence of lumbar vertebrae myoloma with deterioration of neurologic function, he underwent a second curettage with posterior stabilization. Conclusion The WBB classification system prove helpful in developing surgical treatment protocal for these primary spine tumors. 'Radical resection' of primary spine tumor and reconstruction with anterior or posterior stabilization were acceptable and efficacious in management of primary spine tumors.\;