后路一期全脊椎切除术治疗复发性脊柱肿瘤

Total en-bloc spondylectomy for recurrence spinal tumor

目的 探讨后路一期全脊椎切除术在治疗复发性脊柱肿瘤中的临床应用.方法 2010年1月至2013年10月共6例复发性脊柱肿瘤患者在中山大学孙逸仙纪念医院骨科接受后路一期全脊椎切除术.其中男性3例,女性3例;年龄27 ～ 46岁,平均33.2岁.肿瘤位于胸椎5例,腰椎（L1）1例.病理包括骨巨细胞瘤3例,乳腺癌、鼻咽癌、肺癌骨转移各1例.分析6例患者手术时间、出血量、切除节段、手术切缘、神经功能及手术并发症发生情况.结果 切除1节段1例,2节段2例,3节段3例.手术时间7.5～12.0 h,平均8.9h;出血量2500～4500 ml,平均3 116 ml;无手术相关脊髓损伤.术后病理证实边缘无残留.无围手术期死亡病例.合并硬膜撕裂1例,胸膜破裂2例,胸腔大量积血1例.随访12 ～47个月,平均随访23.2个月;至末次随访未发现局部复发.美国脊髓损伤协会神经功能分级：3例术前E级患者术后仍为E级,2例术前C级患者术后恢复至D级,1例术前B级患者无明显恢复.结论 部分复发性脊柱肿瘤仍适合后路全脊椎切除术,但需严格选择手术适应证.

Objective To evaluate the clinical outcomes of total en-bloc spondylectomy （TES） in recurrence spinal tumor.Methods The study was a retrospective study of recurrence spinal tumor from January 2010 to October 2013.A total of 6 patients with recurrent spinal tumor underwent TES procedures,with 5 cases located in thoracic spine and 1 case located in L1.There were 3 male and 3 female patients,with a mean age of 33.2 years.Pathological diagnosis included giant cell tumor of bone in 3 cases,breast cancer,lung cancer and nasopharyngeal carcinoma with 1 case in each.The operation time,bleeding loss,resected segments,cutting edge,spinal cord function and complications was evaluated.Results Single segment resected in 1 case,2 segments resected in 2 cases and 3 segments resected in 3 cases.The average operation time was 8.9 hours （7.5 to 12.0 hours）.The average blood loss was 3 116 ml （2 500 to 4 500 ml）.The average follow-up period was 23.2 months （12 to 47 months） without recurrence.There was no spinal cord injury during operation.The neurologic function was significantly improved in 2 cases （American Spinal Injury Association （ASIA） grade C to grade D）,unchanged in 1 cases （ASIA grade B） and no deteriorated case in 3 cases （ASIA grade E）.There was no perioperative deaths case.Complications included 2 cases pleural rupture,1 case dural tear and 1 case massive haemothorax.No peri-operation death case.Conclusion Some of the recurrent spinal tumors are still suitable for en-bloc resection and TES procedure with the extent of its applicability under strict control.