胸腰椎肿瘤手术中脊柱稳定性的重建

Reconstruction of spinal stability in operation of thoracolumbar tumors.

目的 评价胸腰椎肿瘤术中脊柱稳定性的重建。方法 分析 1 981～ 1 997年胸腰椎肿瘤术中重建脊柱稳定性者 1 2 6例 ,其中椎体肿瘤前路切除后行椎体间植骨融合术 7例 ,椎体间植骨与椎体钉固定术 1 4例 ,椎体间骨水泥填塞与椎体钉固定 36例 ,人工椎体转换术 7例 ;椎弓肿瘤后路切除Luque环固定术 2 4例 ,双Harrington撑开棒与椎板下节段钢丝固定 2 1例 ,经椎弓根螺钉系统固定术 7例。椎体与椎弓肿瘤后路切除Harrington棒与Luque环和椎板下节段钢丝固定各 3例 ;行全脊椎肿瘤切除 ,前方椎体间植骨 ,后方Harrington棒或CD棒固定术 4例。平均随访 5 3年 ,通过临床与影像学检测脊柱重建的稳定性。结果 脊柱稳定性良好者 1 0 8例 (85 7% ) ,其中无瘤生存 37例 ,带瘤生存 9例 ,死亡 62例 ;稳定性丧失 1 8例 (1 4 3 % ) ,其中内固定器松动移位 9例 ,内固定器折断 7例 ,植骨块移位 2例。结论 维持或重建脊柱的稳定性是治疗脊柱肿瘤的一项重要措施 ,可明显提高生活质量。重建稳定性的丧失与肿瘤复发 ,内固定器选择不当 ,安放不妥 。

Objective To evaluate the ways of reconstructing spinal stability in operation of thoracolumbar tumors.Methods One hundred and twenty six cases of thoracolumbar tumors were reviewed from 1981～1997.After anterior resection of tumors in vertebral bodies,7 cases had intervertebral body bone grafting ,14 cases had interbody bone grafting and internal fixation with intervertebral body fixation(IVBF)dual blade plate,36 cases had IVBF dual blade plate with bone cement spacer and 7 cases had artificial vertebral body replacement and after posterior resection of tumors in vertebral arch,24 cases had internal fixation with Luque ring,21 cases had Harrington rods and segmental sublaminar wiring,7 cases had transpedicular screw system 7.After posterior resection of tumor in vertebral body and arch,3 cases had internal fixation with Harrington rods or Luque ring and segmental sublaminar wiring,and 4 cases had anterior intervertebral body bone grafting and posterior fixation with Harrington rods or Cotrel Dubousset(CD)device.The duration of follow up was 5.3 years on average.The reconstructed stability of spine was evaluated by clinic and radiological evidences.Results Spinal stability was good in 108 cases(uneventful survival 37,eventful survival 9,death 62).There was instability in 18 cases(internal fixator loosening 9,internal fixator breakage 7,displacement of grafting bone 2).Conclusion Reconstruction of spinal stability is an important treatment of tumors of spine and can improve life quality of patients.IVBF dualblade plate and interbody plate are suggested in anterior stabilization,transpedicular screw system and CD with segmental wires in posterior stabilization.The loss of restored stability is related to tumor relapse,unsuitable fixators,and insufficiency of grafting bone,and improper motion.