CAJ | 학술논문

目的探讨后路一期全脊椎切除术在治疗复发性脊柱肿瘤中的临床应用.方法 2010年1月至2013年10月共6例复发性脊柱肿瘤患者在中山大学孙逸仙纪念医院骨科接受后路一期全脊椎切除术.其中男性3例,女性3例;年龄27 ～ 46岁,平均33.2岁.肿瘤位于胸椎5例,腰椎(L1)1例.病理包括骨巨细胞瘤3例,乳腺癌、鼻咽癌、肺癌骨转移各1例.分析6例患者手术时间、出血量、切除节段、手术切缘、神经功能及手术并发症发生情况.结果切除1节段1例,2节段2例,3节段3例.手术时间7.5～12.0 h,平均8.9h;出血量2500～4500 ml,平均3 116 ml;无手术相关脊髓损伤.术后病理证实边缘无残留.无围手术期死亡病例.合并硬膜撕裂1例,胸膜破裂2例,胸腔大量积血1例.随访12 ～47个月,平均随访23.2个月;至末次随访未发现局部复发.美国脊髓损伤协会神经功能分级:3例术前E级患者术后仍为E级,2例术前C级患者术后恢复至D级,1例术前B级患者无明显恢复.结论部分复发性脊柱肿瘤仍适合后路全脊椎切除术,但需严格选择手术适应证.
목적 탐토후로일기전척추절제술재치료복발성척주종류중적림상응용.방법 2010년1월지2013년10월공6례복발성척주종류환자재중산대학손일선기념의원골과접수후로일기전척추절제술.기중남성3례,녀성3례;년령27 ～ 46세,평균33.2세.종류위우흉추5례,요추(L1)1례.병리포괄골거세포류3례,유선암、비인암、폐암골전이각1례.분석6례환자수술시간、출혈량、절제절단、수술절연、신경공능급수술병발증발생정황.결과 절제1절단1례,2절단2례,3절단3례.수술시간7.5～12.0 h,평균8.9h;출혈량2500～4500 ml,평균3 116 ml;무수술상관척수손상.술후병리증실변연무잔류.무위수술기사망병례.합병경막시렬1례,흉막파렬2례,흉강대량적혈1례.수방12 ～47개월,평균수방23.2개월;지말차수방미발현국부복발.미국척수손상협회신경공능분급:3례술전E급환자술후잉위E급,2례술전C급환자술후회복지D급,1례술전B급환자무명현회복.결론 부분복발성척주종류잉괄합후로전척추절제술,단수엄격선택수술괄응증.
Objective To evaluate the clinical outcomes of total en-bloc spondylectomy (TES) in recurrence spinal tumor.Methods The study was a retrospective study of recurrence spinal tumor from January 2010 to October 2013.A total of 6 patients with recurrent spinal tumor underwent TES procedures,with 5 cases located in thoracic spine and 1 case located in L1.There were 3 male and 3 female patients,with a mean age of 33.2 years.Pathological diagnosis included giant cell tumor of bone in 3 cases,breast cancer,lung cancer and nasopharyngeal carcinoma with 1 case in each.The operation time,bleeding loss,resected segments,cutting edge,spinal cord function and complications was evaluated.Results Single segment resected in 1 case,2 segments resected in 2 cases and 3 segments resected in 3 cases.The average operation time was 8.9 hours (7.5 to 12.0 hours).The average blood loss was 3 116 ml (2 500 to 4 500 ml).The average follow-up period was 23.2 months (12 to 47 months) without recurrence.There was no spinal cord injury during operation.The neurologic function was significantly improved in 2 cases (American Spinal Injury Association (ASIA) grade C to grade D),unchanged in 1 cases (ASIA grade B) and no deteriorated case in 3 cases (ASIA grade E).There was no perioperative deaths case.Complications included 2 cases pleural rupture,1 case dural tear and 1 case massive haemothorax.No peri-operation death case.Conclusion Some of the recurrent spinal tumors are still suitable for en-bloc resection and TES procedure with the extent of its applicability under strict control.