全脊椎切除及脊柱稳定性重建治疗颈胸段脊柱肿瘤的疗效分析

Efficacy of total spondylectomy and spinal stability reconstruction for cervicothoracic spinal tumors

中文关键词:  脊柱肿瘤  颈胸段  全脊椎切除  手术方式  脊柱重建

英文关键词:Spinal tumor  Cervicothoracic junction  Total spondylectomy  Surgical strategy  Spinal reconstruction

中文摘要:

  【摘要】 目的：探讨颈胸段脊柱肿瘤全脊椎切除的手术方式、脊柱重建策略及治疗效果。方法：回顾性分析我院自2008年1月～2013年12月行全脊椎切除术治疗的颈胸段脊柱肿瘤病例11例，病理诊断包括骨巨细胞瘤5例，骨母细胞瘤1例，Ewing肉瘤1例，浆细胞性骨髓瘤1例，甲状腺滤泡型转移癌2例，前列腺转移癌1例。患者均有不同程度的胸背部疼痛，术前VAS评分为7.45±0.82分；脊髓损伤神经功能Frankel分级B级1例，C级3例，D级6例，E级1例。所有病例术前根据Tomita脊柱肿瘤外科分期评估均为间室外病变。4例C7～T1段肿瘤行一期前后联合入路全脊椎切除，前方钛网、钛板重建；7例T2～T4段肿瘤行单一后路整块全脊椎切除（TES），前方单纯钛网重建。两种术式后方均为钉棒系统重建。观察患者术中术后并发症以及脊柱重建稳定性情况。结果：手术时间298～573min，平均423.9min；术中失血量800～3800ml，平均2077ml。4例术中胸膜破裂，2例术后神经功能一过性下降，7例术中结扎病椎神经根，残留轻度胸前区不适。所有患者均获随访，平均随访34.7个月，1例前列腺转移癌患者死亡，其余均无局部复发。术后患者疼痛明显改善，VAS评分由术前7.45±0.82分下降至术后2.55±0.69分（P＜0.05）。术后神经功能2例（术前D级1例，E级1例）保持原有水平，余均获得改善，均未出现内固定失败。结论：全脊椎切除治疗颈胸段脊柱肿瘤可以获得满意的局部控制，缓解疼痛，改善神经功能，应根据肿瘤位于颈胸段脊柱近端（C7～T1）或远端（T2～T4）而制定个体化手术方式及脊柱重建策略。

英文摘要:

  【Abstract】 Objectives: To investigate the surgical technique, spinal reconstruction and outcomes of total spondylectomy for cervicothoracic tumors. Methods: From January 2008 to December 2013, 11 patients with cervicothoracic spinal tumors underwent total spondylectomy in our department. Histological results included 5 giant cell tumors, 1 osteoblastoma, 1 Ewing sarcoma, 2 metastatic thyroid follicular carcinoma and 1 metastatic prostate carcinoma. All patients had chest and back pain, the VAS score was 7.45±0.82. The Frankel grade of neurological function was B in 1, C in 3, D in 6 and E in 1. According to the Tomita surgical classification of vertebral tumors, all the 11 lesions were considered as extracompartment. 4 patients with upper cervicothoracic spinal tumors(C7-T1) received one stage total spondylectomy via combined anterior-posterior approach, the anterior spinal stability was reconstructed by titanium mesh and plate. 7 patients with lower cervicothoracic spinal tumors(T2-T4) received total en-bloc spondylectomy(TES) though the posterior approach, the anterior spinal stability was reconstructed by titanium mesh without plate. The posterior spinal stability of all cases were reconstructed with the screw-rod system. The intra- and post-operative complications and imaging follow-up data were recorded. Results: The mean operation time was 423.9min(298-573min) and the mean blood loss was 2077ml(800-3800ml). Intraoperative complication included matter tearing in 4 patients. Postoperative complications occurred in 7 patients, which included transient decrease of neurological functions in 2 patients, residual slightly chest discomfort in 7 patients with ligated nerve roots. All patients received follow-up with an average time of 34.7 months. One patient with metastatic prostate carcinoma died of severe organs failure and no local recurrence was found in the others. 11 patients showed significant pain relief, VAS score decreased from 7.45±0.82 points at preoperation to 2.55±0.69 points at postoperation(P＜0.05). Postoperative neurological functions were improved except of 2 cases(1 in D and 1 in E had no change) and no instrument failure was noted. Conclusions: Total spondylectomy for cervicothoracic spinal tumors can provide a satisfied local control, pain relief and improvement of neurological status. According to cervicothoracic spinal tumor location, the upper(C7-T1) or lower(T2-T4) should be considered different surgical techniques and spinal reconstructions.