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目的:探讨一期后路全脊椎切除、环脊髓减压、植骨及内固定治疗胸椎肿瘤的手术指征及临床效果。方法:对11例累及胸椎(按改良Tomita分期为Ⅳ期和Ⅴ期)的肿瘤患者采取一期后路全脊椎切除、环脊髓减压、植骨及内固定术,其中大块自体髂骨植骨9例,异体皮质骨笼+自体松质骨椎体间植骨2例;脊柱内固定应用CD2例,TSRH8例,AXIS1例。结果:手术时间225~425min,平均285min,术中出血750~3200ml,平均1650ml。边缘或整块切除3例,病灶内分块+边缘切除8例。术后经8~36个月(平均18.3个月)随访,2例甲状腺癌转移患者1例于术后8个月发生多处转移,器官衰竭而死亡;另1例于术后14个月局部软组织内肿瘤复发及其它部位转移而放弃治疗,术后21个月死亡;1例滑膜软骨肉瘤于术后10个月发现肺部多处转移,术后17个月死亡;余8例存活,随访中无局部复发、转移或内固定失效等。7例术前伴脊髓神经功能损害者,术后6例获显著改善。结论:对累及胸椎的Ⅳ期和Ⅴ期肿瘤采取一期后路全脊椎切除、稳定性重建,创伤小、并发症少。
Objective: To investigate the surgical indications and clinical effects of posterior total spondylectomy, annulus decompression, bone grafting and internal fixation in the treatment of thoracic tumors. Methods: A total of 11 patients with tumors involving the thoracic spine (stage Ⅳ and stage Ⅴ according to modified Tomita stage) underwent total anterior total spondylectomy, cricothyroid decompression, bone grafting and internal fixation. The large autologous iliac bone graft Bone in 9 cases, allograft cortical + autologous cancellous bone interbody fusion in 2 cases; spine application of CD2 cases, TSRH8 cases, AXIS1 cases. Results: The operation time ranged from 225 to 425 minutes, with an average of 285 minutes. The intraoperative bleeding ranged from 750 to 3200ml with an average of 1650ml. 3 cases were marginal or entire resection, 8 cases were resected in the lesion + marginal resection. After 8 to 36 months (range, 18.3 months), one case of thyroid carcinoma metastasized in 2 cases occurred multiple metastases at 8 months after operation, and died of organ failure. The other 1 case was localized at 14 months after operation One case of synovial chondrosarcoma was found to have metastasized to the lung at 10 months after operation and died at 17 months after operation. The remaining 8 cases survived, No follow-up of local recurrence, metastasis or internal fixation failure. Seven patients with preoperative spinal cord nerve dysfunction were significantly improved after 6 cases. CONCLUSION: One-stage posterior total spondylectomy for stage IV and V tumors involving the thoracic spine with stable reconstruction and less trauma and fewer complications.