胸腰椎肿瘤全脊椎整块切除初步应用和手术方法改进.docVIP

胸腰椎肿瘤全脊椎整块切除初步应用及手术方法改进 　　作者：李建民，阎 峻，杨志平，李 昕，李振峰，杨 强 作者单位：山东大学齐鲁医院骨科，济南 　　【摘要】 [目的] 探讨全脊椎整块切除术(total en-bloc spondylectomy,TES)治疗脊椎肿瘤的可行性与临床价值。[方法] 采用全脊椎整块切除术治疗4例原发胸腰椎脊柱肿瘤，其中行单一后路全脊椎切除3例(包括：T10单发浆细胞瘤1例，T8全脊椎血管瘤1例，和T12全脊椎血管瘤1例);行前后联合入路全脊椎切除1例(为L4神经母细胞瘤并椎旁肿块)，并对标准TES手术中的截骨器械和手术技巧进行改进。[结果]所有患者术后临床症状均明显改善，未出现严重手术并发症。随访时间13～22个月，至末次随访时，所有患者均未出现局部复发和远处转移。[结论]全脊椎整块切除术一改传统分块切除脊椎肿瘤的方式，将脊椎分为前后两部分予以完整切除，被认为是目前治疗脊椎肿瘤最为积极有效地手术方法之一，而其手术方法和技巧尚待进一步改进。 　　【关键词】 脊椎肿瘤，骨科手术方法，脊椎整块切除 　　Total en bloc spondylectomy for tumor of the thoracolumbar spine∥LI Jian-min, YAN Jun,YANG Zhi-ping,et al.Department of Orthopaedics,Qilu Hospital,Shandong University,Jinan,Shandong,250012,China 　　Abstract: [Objective]To evaluate the possibility and clinical value of total en bloc spondylectomy for the treatment of spinal tumors. [Method]Four cases of primary tumor of the thoracolumbar spine were treated with total en bloc spondylectomy TES through a single posterior approach performed in three cases(T10 solitary plasmacytoma,T8 hemangioma,and T12 hemangioma),and one case through a single stage anterior and posterior combined approach (L4 neuroblastoma with paraspinal mass).Improvements in osteotomy apparatus and surgical technique of TES were investigated.[Result]All patients attained significant clinical improvement after surgery without any severe complications.Patients were observed for 13 to 22 months.There was no local recurrence and distal metastasis by the last follow-up.[Conclusion]Total en bloc spondylectomy includes resection of the involved vertebra in two major blocs,rather than a piecemeal pattern.It is one of the most effective therapies for spinal tumors.Howerer,some components of TES remain to be further improved. 　　Key words：spinal neoplasms; orthopedic procedures; en bloc spondylectomy 　　脊柱肿瘤的传统治疗方式中，以病灶刮除或分块切除肿瘤为主。一般治疗原则为早期发现并彻底切除。尽管整块切除术已成为肢体肿瘤手术的标准切除方式，但由于脊椎肿瘤与邻近的脊髓神经血管及脏器关系复杂，故以往只能采用分块逐步切除肿瘤组织或从椎体肿瘤内部予以切除和刮除。传统手术的缺点在于肿瘤切除不彻底及手术区域污染严重而导致较高的局部复发率，而复发的脊椎肿瘤几乎无法再次