胸腰椎肿瘤椎体矢状切除的安全性和有效性

Safety and efficacy of sagittal vertebral resection of thoracolumbar spinal tumors

中文关键词:  胸椎肿瘤  腰椎肿瘤  矢状切除  并发症  分型

英文关键词:Thoracic vertebral tumors  Lumbar vertebral tumor  Sagittal resection  Complication  Type

中文摘要:

  【摘要】 目的：评价椎体矢状切除技术在胸腰椎肿瘤中的安全性、有效性，探讨椎体分区、分型对手术的指导意义。方法：以椎体椎弓根的内侧缘、外侧缘和椎体中线为界，将椎体的解剖部位对称地分为Ⅰ/Ⅱ/Ⅲ区，并根据此分区进行分型，Ⅰ型，肿瘤累及Ⅰ区，矢状切除范围为同侧Ⅰ～Ⅱ区；Ⅱ型，肿瘤累及Ⅱ区，矢状切除同侧Ⅰ～Ⅲ区；Ⅲ型，肿瘤累及Ⅲ区，矢状切除同侧Ⅰ～Ⅲ区及对侧Ⅲ区。根据纳入排除标准，收集于2018年6月～2021年12月在我科进行胸腰椎肿瘤矢状切除的患者共8例，男性6例（75%），女性2例（25%），平均年龄37.8±4.8岁。骨肉瘤2例，软组织肉瘤2例，转移癌2例，良性局部侵袭性肿瘤2例。Ⅰ型1例，Ⅱ型2例，Ⅲ型5例。分别收集患者一般资料、手术相关临床数据，包括肿瘤累及分区、手术时间、术中失血量、重建方式、手术并发症、复发率、远期并发症、Frankel分级，随访观察该术式的治疗效果。结果：随访时间22.3±3.9个月（12～40个月），术中失血量为1812.5±333.0ml，手术时间为369.6±27.7min。有1例软组织切缘阳性，因患者在外院首次手术造成硬膜粘连，我院进行第二次手术；所有患者骨切缘均为阴性。肿瘤学结果包括1例肿瘤局部复发合并远处转移，局部复发率12.5%（1/8），1例远处转移，无感染及死亡病例，未见内固定失败病例。Frankel分级手术后未见恶化情况。结论：基于我们提出的分区、分型系统，可以有效指导胸腰椎肿瘤的椎体矢状切除，保留部分椎体，有助于减少手术并发症。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and effectiveness of sagittal vertebral resection in thoracolumbar spinal tumors and explore the guiding significance of vertebral partitioning and classification for surgery. Methods: The anatomic sites of vertebra were symmetrically divided into Ⅰ/Ⅱ/Ⅲ zones by the inner and outer edges of the pedicle and the midline of the vertebral body. The surgical classification of the vertebral tumors for sagittal excision in our system was based on the tumor involvement in different anatomic zones of the vertebra, which was classified into type Ⅰ: tumor involved zone Ⅰ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅱ; type Ⅱ: tumor involved zone Ⅱ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅲ; and type Ⅲ: tumor involved in the vertebral body of zone Ⅲ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅲ and contralateral zone Ⅲ. According to the inclusion and exclusion criteria, 8 patients with thoracolumbar spinal tumors who underwent sagittal resection in our department from June 2018 to December 2021 were collected and analyzed, including 6 males(75%) and 2 females(25%) with an average age of 37.8±4.8 years. There were 2 cases of osteosarcoma, 2 cases of soft tissue sarcomas, 2 cases of metastatic cancers and 2 cases of benign locally aggressive tumor. And 1 case of the patients was of type Ⅰ, 2 were of type Ⅱ and 5 were of type Ⅲ. The general information and perioperative clinical data including tumor involved zone, operation time, intraoperative blood loss, reconstruction method, surgical complications, recurrence rate, long-term complications, and Frankel grade of the patients were collected and analyzed. Results: The average follow-up time was 22.3±3.9 months(12-40 months), average intraoperative blood loss was 1812.5±333.0ml, and average operation time was 369.6±27.7min. 1 case with positive margin of soft tissue resection due to dural adhesions caused by the first operation in another hospital underwent a second surgery in our hospital, and after which the margin of bone resection was negative. The results of oncology included 1 case with local recurrence and distant metastasis with a local recurrence rate of 12.5%(1/8), 1 case with distant metastasis, none infection or death, and none failed internal fixation. No deterioration was observed in Frankel grading after surgery. Conclusions: Our proposed zoning and classification system can effectively guide the sagittal vertebral resection in thoracolumbar spinal tumors and preserve partial vertebral bodies, therefore reduce the surgical complications.