18例经后路脊柱肿瘤切除植骨稳定性重建疗效观察

Clinical effects of total en bloc spondylectomy and spinal stability reconstruction on 18 patients with spinal tumors

目的：探讨经后路行全脊椎切除术治疗良恶性脊柱肿瘤的方法和近远期疗效,评价其可行性及临床价值。方法：回顾18例肿瘤侵及椎体及附件的脊柱肿瘤患者的临床资料,所有患者均在一期经后路切除肿瘤的同时行钛网植骨融合、椎弓根钉内固定系统固定治疗。随访6~40个月,随访内容包括：手术时间、术中失血量、手术并发症、术后疼痛缓解情况、神经功能恢复情况、脊柱稳定性情况、肿瘤复发、生存时间及生活质量。结果：所有患者均获得完整随访,手术时间210~360 min;术中失血量800~1 800 m L;2例胸椎椎体肿瘤切除术中胸膜破裂,所有切口均一期愈合,无其它严重并发症;17例术前有神经功能障碍者,术后均获得显著改善;所有病例术后脊柱结构稳定;1例乳腺癌患者术后7个月复发放弃治疗,1例肾癌术后12个月原发肿瘤部位复发死亡,2例前列腺癌术后24个月死于多器官转移,其余患者至末次随访时脊柱稳定性良好,神经功能改善,无局部复发。结论：经后路全脊椎切除术联合植骨稳定性重建是治疗脊柱肿瘤的一种有效的手术方法,可改善神经功能、降低局部复发率,显著改善患者的生存质量。

Objective： To investigate the methods and efficacy of total en bloc spondylectomy and to evaluate its feasibility and clinical value. Methods：Review eighteen cases of spinal tumor which violated the vertebral body and attachments were reviewed. All patients underwent one-stage total en bloc spondylectomy Combined with implantation of titanium mesh filled by bone and posterior pedicle screw system via posterior approach. All cases were followed up 6 months to 40 months, which included： operation time, surgical blood loss, operative complications, postoperative pain and neural function recovery, spinal stability conditions, tumor recurrence, survival time and quality of life. Results：All patients received complete follow-up, the operation time 210-360 min; surgical blood loss 800-1 800 mL; 2 cases of thoracic tumor patients＇pleura was ruptured in operation, while other patients had no serious complications; 17 cases of preoperative patients with neurological dysfunction were significantly improved after surgery. All cases of postoperation had stable spinal structure. Among them, one case of breast cancer recurred 7 months after operation, one case of renal carcinoma recurred 12 months after operation, two cases of prostatic cancer died from distant metastasis 24 months after operation. The other cases were found alive at final follow-up with good spinal stability and no local recurrence. Conclusion： Total en bloc spondylectomy and spinal stability reconstruction is an effective surgical treatment for spinal tumor. It can improve neurofunction, decrease local recurrence and significantly improve living quality of patients.