一期后路全脊椎切除治疗胸腰椎恶性肿瘤

En bloc spondylectomy for thoracolumbar spinal malignant tumors via posterior approach

中文关键词:  脊柱肿瘤  全脊椎切除  整块切除  分块切除  后路

英文关键词:Spinal tumor  Total spondylectomy  En bloc resection  Piecemeal resection  Posterior approach

中文摘要:

  【摘要】 目的：探讨一期后路全脊椎切除治疗胸腰椎恶性肿瘤的可行性、安全性和疗效。方法：回顾分析2004年5月至2009年12月复旦大学附属中山医院骨科收治的40例胸腰椎恶性肿瘤患者的临床资料。均采用一期后路全脊椎切除治疗，其中分块切除23例，整块切除17例。比较两组患者手术时间、术中出血量、术中输血量和临床治疗效果等。结果：分块切除组手术时间4.8~7h，平均5.8h，术中出血量1500~5000ml，平均2705ml，术中输血量平均1769ml，术后随访6～68个月，平均18个月，随访期内死亡5例，8例肿瘤复发，骨水泥陷入椎体和移位各1例；整块切除组手术时间6.5~8h，平均7.3h，术中出血量1000~2000ml，平均1678ml，术中输血量平均1087ml，随访期间未发现肿瘤复发，除1例钛网轻度移位外，余内固定可靠。两组术后VAS评分有明显下降，与术前相比有显著性差异（P<0.05），两组间VAS改善无统计学差异（P>0.05）。两组在手术时间、术中出血量和术中输血量比较有显著性差异（P<0.05）。脊髓神经功能Frankel分级３２例患者均有1级以上恢复。结论：一期后路全脊椎切除治疗胸腰椎恶性肿瘤安全有效。整块切除法在术中出血量、术中输血量和局部复发率方面明显优于分块切除法。

英文摘要:

  【Abstract】 Objective：To investigate the feasibility，safety and clinical outcome of en bloc spondylectomy via posterior approach for thoracolumbar spinal malignant tumors.Method：From May 2004 to December 2009，a total of 40 cases with thoracolumbar spinal malignant tumors underwent spondylectomy via posterior approach in our institute.The mean fellow-up was 18 months（range，6-68 months）.23 cases experienced piecemeal spondylectomy and 17 cases experienced en bloc spondylectomy.The surgical time，amount of intraoperative blood loss，blood transfusion volume，VAS scores and Frankel grade of each patient were evaluated and compared.Result：In piecemeal group，the average operation time was 5.8 hours（range，4.8-7 hours）；the average blood loss was 2705ml（range，1500-5000ml） and the average intraoperative transfusion volume was 1769ml.5 death，8 recurrence，1 bone cement subsidence and 1 bone cement displacement were noted in piecemeal group.While in en bloc group，the average operation time was 7.3 hours（range，6.5-8 hours）；the average blood loss and transfusion volume was 1678ml（range，1000-2000ml）and 1087ml respectively.No recurrence was found in en bloc group and only one case was complicated with slight titanium mesh displacement.Postoperative VAS scores in both groups were significantly lower than the preoperative ones（P<0.05），while no statistical differences were found between two groups（P>0.05）.Statistical difference was noted between the two groups with regard to operative time，amount of intraoperative blood loss and intraoperative blood transfusion volume（P<0.05）.Thirty-two patients had neurofunction improved at least one Frankel grade after surgery.Conclusion：En bloc via the posterior approach for the thoracolumbar spinal malignant is reliable，which is superior over piecemeal spondylectomy in intraoperative blood loss，blood transfusion volume and local recurrence.