脊柱原发肿瘤课件.pptVIP

* * 二、 原发性脊柱肿瘤的外科治疗 党耕町 A、骨外软组织区 B、骨膜内（浅层） C、骨膜内（深层） D、椎管内（硬膜外） E、椎管内（硬膜内） F、侵犯脊柱动脉 Primary Bone Tumors of the Spine: Terminology and Surgical Staging.Spine. 22(9):1036-1044, May 1, 1997. A-C：良性肿瘤 A：1期，静止期（inactive） B：2期，形成薄的囊壁（1）和假包膜（2） C：3期，囊壁薄而不连续（1）和周围明显炎性反应（2） D-G：恶性肿瘤 D：IA期，囊壁很薄（1）、假包膜宽大（2）且含有岛状肿瘤 E：IB期，囊壁很薄（1）、假包膜宽大（2）且含有岛状肿瘤，瘤体向外生长 F：IIA期，假包膜被瘤体穿透（2，3），岛状瘤体远离瘤体（4） G：IIB期，瘤体向椎体外生长，假包膜被瘤体穿透（2，3），岛状瘤体远离瘤体（4） 脊柱肿瘤WBB分期 外科治疗方式 ? Lippincott-Raven Publishers. Published by Lippincott Williams Wilkins, Inc. 5 Figure Primary Bone Tumors of the Spine: Terminology and Surgical Staging. Boriani, Stefano; Weinstein, James; Biagini, Roberto Spine. 22(9):1036-1044, May 1, 1997. Figure 4. A, Indication for vertebrectomy. The en bloc excision of a tumor occurring in the vertebral body can be performed with an oncologically appropriate margin if at least one pedicle is free from tumor. B, A posterior stage is performed to remove the posterior elements, cut the longitudinal ligament, and separate the anterior surface of the dura from the posterior wall. The anterior approach is mandatory for a careful respect of the margins if the tumor is growing outside the vertebra. ? Lippincott-Raven Publishers. Published by Lippincott Williams Wilkins, Inc. 6 Figure 5 Primary Bone Tumors of the Spine: Terminology and Surgical Staging. Boriani, Stefano; Weinstein, James; Biagini, Roberto Spine. 22(9):1036-1044, May 1, 1997. Figure 5 . Metastatic osteosarcoma arising from the L4 vertebral body, occupying the left pedicle and expanding into the psoas muscle. The patient had been treated with en bloc excision and neo-adjuvant therapy for proximal humerus osteosarcoma 6 months earlier. No biopsy had been performed on the vertebral tumor. A, Enneking staging: stage 11B (high-grade malignant, extracompartmental). WBB staging: zones 4 to 7, layers A to C. B, Radiographs of the specimen showing an en bloc resection including the psoas muscle. The histologic study confirmed