BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to ...BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.展开更多
Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of mo...Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified展开更多
目的:系统分析3D打印人工椎体在脊柱肿瘤全脊椎切除术(total en bloc spondylectomy,TES)脊柱重建中的有效性与安全性。方法:通过检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)...目的:系统分析3D打印人工椎体在脊柱肿瘤全脊椎切除术(total en bloc spondylectomy,TES)脊柱重建中的有效性与安全性。方法:通过检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库和维普系列数据库,收集各数据库建库至2022年8月有关脊柱肿瘤TES中应用3D打印人工椎体脊柱重建的文献,研究类型为非随机对照试验,包括双臂试验(依据置入物不同分为3D组与钛网组)和单臂试验,采用非随机研究方法学指数(methodological index for non-randomized studies,MINORS)对纳入研究进行质量评价。提取纳入研究的结局指标:手术时间、术中出血量、早期并发症发生率、椎体融合率、内置物沉降率、脊髓损伤Frankel分级(A~E级分别计分1~5分)。使用Stata 14.0软件对相关指标进行Meta分析。结果:共有13篇相关文献被纳入,8项研究为临床单臂试验,文献评分为12~13分,均为中等质量研究,总样本量为140例;5项研究为临床双臂试验,文献评分为19~20分,均为高质量研究,3D组的总样本量为115例,钛网组总样本量为126例。Meta分析结果显示:双臂试验示3D组的手术时间(MD=-287.14,95%CI-391.30~-182.99,P=0.00)、术中出血量(MD=-2.87,95%CI-5.11~-0.63,P=0.01)低于钛网组;单臂试验示早期并发症发生率为23%(95%CI 0.16~0.31),双臂试验示两组早期并发症发生率(RR=0.56,95%CI 0.32~1.00,P=0.05)无显著性差异;单臂试验示术后脊髓损伤Frankel分级较术前获得约1个等级的改善(MD=1.04,95%CI 0.32~1.76,P=0.03),双臂试验结果示两组术后脊髓损伤Frankel分级无显著性差异(MD=-0.13,95%CI-0.45~0.19,P=0.42);单臂试验示与相邻椎体的融合率为93%(95%CI 0.79~1.00),双臂试验仅1篇文献报告了融合率,故未进行Meta分析;单臂试验示置入物沉降率为4%(95%CI 0.01~0.07),双臂试验示3D组置入物沉降率低于钛网组(RR=0.15,95%CI 0.05~0.45,P=0.001)。结论:3D打印人工椎体在脊柱肿瘤TES脊柱重建中应用具有手术时间短,术中出血量少,与相邻椎体融合率高,置入物沉降率低等优势,术后脊髓损伤神经功能恢复好,疗效较为显著。展开更多
目的研究3D打印个体化人工椎体重建用于脊柱肿瘤术后的临床价值。方法选择医院收治的60例脊柱肿瘤患者为研究对象,使用随机数表法将其分为观察组和对照组,各30例。两组均行多节段椎体切除术,观察组采用3D打印人工椎体重建脊柱序列,对照...目的研究3D打印个体化人工椎体重建用于脊柱肿瘤术后的临床价值。方法选择医院收治的60例脊柱肿瘤患者为研究对象,使用随机数表法将其分为观察组和对照组,各30例。两组均行多节段椎体切除术,观察组采用3D打印人工椎体重建脊柱序列,对照组采用钛网材料重建脊柱序列。比较两组围术期指标,包括切除节段数、术中出血量、手术时间、住院时间、术后7 d视觉模拟评分法(VAS)评分;比较两组不同时点日本骨科协会评估治疗(JOA)评分;分别于术后1周、术后1、3个月测量融合节段椎体前缘高度(HAB)、椎体后缘高度(HPB)、cobb角度,并计算术后1、3个月HAB、HPB、cobb角度下降值;比较两组术后并发症发生情况。结果与对照组相比,观察组术中出血量较低、手术时间较短(P<0.05);两组切除节段数、住院时间、术后7 d VAS评分差异无统计学意义(P>0.05);术后1周至术后3个月,两组JOA评分均呈上升趋势(P<0.05);与对照组相比,观察组术后1周、术后1、2、3个月JOA评分均较高(P<0.05);与对照组相比,观察组术后1、3个月HAB减小值、HPB减小值、cobb角减小值均较小(P<0.05);两组术后并发症发生率差异无统计学意义(P>0.05)。结论3D打印个体化人工椎体重建用于脊椎肿瘤切除术,有利于缩短手术时间、减低术中出血量、促进脊柱神经功能恢复、降低内植物沉降速度。展开更多
基金Supported by The Shanghai Municipal Health Commission Clinical Research Project,No.202140140.
文摘BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.
文摘Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified
文摘目的:系统分析3D打印人工椎体在脊柱肿瘤全脊椎切除术(total en bloc spondylectomy,TES)脊柱重建中的有效性与安全性。方法:通过检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库和维普系列数据库,收集各数据库建库至2022年8月有关脊柱肿瘤TES中应用3D打印人工椎体脊柱重建的文献,研究类型为非随机对照试验,包括双臂试验(依据置入物不同分为3D组与钛网组)和单臂试验,采用非随机研究方法学指数(methodological index for non-randomized studies,MINORS)对纳入研究进行质量评价。提取纳入研究的结局指标:手术时间、术中出血量、早期并发症发生率、椎体融合率、内置物沉降率、脊髓损伤Frankel分级(A~E级分别计分1~5分)。使用Stata 14.0软件对相关指标进行Meta分析。结果:共有13篇相关文献被纳入,8项研究为临床单臂试验,文献评分为12~13分,均为中等质量研究,总样本量为140例;5项研究为临床双臂试验,文献评分为19~20分,均为高质量研究,3D组的总样本量为115例,钛网组总样本量为126例。Meta分析结果显示:双臂试验示3D组的手术时间(MD=-287.14,95%CI-391.30~-182.99,P=0.00)、术中出血量(MD=-2.87,95%CI-5.11~-0.63,P=0.01)低于钛网组;单臂试验示早期并发症发生率为23%(95%CI 0.16~0.31),双臂试验示两组早期并发症发生率(RR=0.56,95%CI 0.32~1.00,P=0.05)无显著性差异;单臂试验示术后脊髓损伤Frankel分级较术前获得约1个等级的改善(MD=1.04,95%CI 0.32~1.76,P=0.03),双臂试验结果示两组术后脊髓损伤Frankel分级无显著性差异(MD=-0.13,95%CI-0.45~0.19,P=0.42);单臂试验示与相邻椎体的融合率为93%(95%CI 0.79~1.00),双臂试验仅1篇文献报告了融合率,故未进行Meta分析;单臂试验示置入物沉降率为4%(95%CI 0.01~0.07),双臂试验示3D组置入物沉降率低于钛网组(RR=0.15,95%CI 0.05~0.45,P=0.001)。结论:3D打印人工椎体在脊柱肿瘤TES脊柱重建中应用具有手术时间短,术中出血量少,与相邻椎体融合率高,置入物沉降率低等优势,术后脊髓损伤神经功能恢复好,疗效较为显著。
文摘目的研究3D打印个体化人工椎体重建用于脊柱肿瘤术后的临床价值。方法选择医院收治的60例脊柱肿瘤患者为研究对象,使用随机数表法将其分为观察组和对照组,各30例。两组均行多节段椎体切除术,观察组采用3D打印人工椎体重建脊柱序列,对照组采用钛网材料重建脊柱序列。比较两组围术期指标,包括切除节段数、术中出血量、手术时间、住院时间、术后7 d视觉模拟评分法(VAS)评分;比较两组不同时点日本骨科协会评估治疗(JOA)评分;分别于术后1周、术后1、3个月测量融合节段椎体前缘高度(HAB)、椎体后缘高度(HPB)、cobb角度,并计算术后1、3个月HAB、HPB、cobb角度下降值;比较两组术后并发症发生情况。结果与对照组相比,观察组术中出血量较低、手术时间较短(P<0.05);两组切除节段数、住院时间、术后7 d VAS评分差异无统计学意义(P>0.05);术后1周至术后3个月,两组JOA评分均呈上升趋势(P<0.05);与对照组相比,观察组术后1周、术后1、2、3个月JOA评分均较高(P<0.05);与对照组相比,观察组术后1、3个月HAB减小值、HPB减小值、cobb角减小值均较小(P<0.05);两组术后并发症发生率差异无统计学意义(P>0.05)。结论3D打印个体化人工椎体重建用于脊椎肿瘤切除术,有利于缩短手术时间、减低术中出血量、促进脊柱神经功能恢复、降低内植物沉降速度。
