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目的:探讨胸腰椎肿瘤全脊椎切除术后脊柱稳定性的重建方式。方法:1993￣2003年我院治疗各类胸腰椎(T5￣L5)肿瘤患者72例,其中全脊椎切除、随访2年以上、没有肿瘤复发和转移且有完整影像学资料者12例,骨巨细胞瘤9例,单发浆细胞性骨髓瘤2例,非何杰金氏淋巴瘤1例。一期前后路联合全脊椎切除11例,次全脊椎切除1例,以5种不同方式重建,分别为前路内固定加后路短节段经椎弓根内固定(ASP)5例、前路内固定加后路多节段Luque环内固定(AMP)4例、单纯后路短节段经椎弓根内固定(SP)1例、单纯后路多节段经椎弓根内固定(MP)1例、单纯前路内固定(A)1例。观察术前、术后即刻及末次随访时矢状面Cobb角度变化、植骨融合情况、有无植骨骨折及下沉等并发症。结果:随访2.5￣13年,平均6.6年。ASP方式重建的5例患者矢状面Cobb角丢失0°～7°,平均2.4°,植骨全部融合,无植骨骨折,1例因术中损伤终板而出现人工椎体轻度下沉。AMP方式重建的4例患者矢状面Cobb角丢失0°～9°,平均5°,植骨全部融合,无植骨骨折或下沉;其中1例术后1.5年植骨融合后取出后方固定,仅保留前方固定,出现植骨骨折及后凸畸形。SP或MP方式重建的2例患者矢状面Cobb角分别丢失12°和13°,植骨块均骨折。次全脊椎切除A方式重建的1例患者矢状面Cobb角无丢失,植骨融合且无植骨骨折及下沉。结论:本组病例较少,但初步可以看出ASP和AMP是全脊椎切除后坚强的重建方式,能够使植骨顺利融合,防止Cobb角度丢失。但ASP能够减少固定节段、保留运动单元,是更好的固定方式。SP和A不宜单独应用于全脊椎切除后稳定性重建。
Objective: To investigate the reconstruction of spinal stability after total spondylectomy for thoracolumbar tumors. Methods: From 1993 to 2003, 72 cases of various types of thoracolumbar (T5 ~ L5) tumors were treated in our hospital. Among them, total spondylotomy was followed up for more than 2 years. There were 12 patients with complete tumor imaging without tumor recurrence and metastasis, 9 cases of cell tumor, 2 cases of single plasma cell myeloma and 1 case of non-Hodgkin’s lymphoma. An anterior and posterior combined total spondylectomy in 11 cases, subtotal splenectomy in 1 case, in 5 different ways to reconstruct, were anterior fixation and posterior short segment by pedicle screw fixation (ASP) in 5 cases, before 4 cases were treated with multi-segmental Luque ring fixation (AMP) in the road and 1 case with simple posterior segmental pedicle screw fixation (SP). Only posterior multi-segmental pedicle screw fixation MP) in 1 case, simple anterior fixation (A) in 1 case. The changes of sagittal Cobb angle, grafting and fusion, the presence or absence of bone fracture and subsidence were observed before operation, immediately after operation and at the last follow-up. Results: Followed by 2.5 to 13 years, an average of 6.6 years. In 5 patients reconstructed by ASP, the sagittal Cobb angle lost 0 ° ~7 °, with an average of 2.4 °. All the bone grafts were fused without any bone graft fracture. One case suffered slight subsidence of the artificial vertebral body . In 4 patients with AMP reconstruction, the sagittal Cobb angle lost 0 ° ~ 9 ° with an average of 5 °. All the bone grafts were fused without any bone fracture or subsidence. One of them was fixed after 1.5 years of graft fusion and posterior fixation , Leaving only the front of the fixed, there bone fractures and kyphosis. In 2 patients reconstructed by SP or MP, the sagittal Cobb angle was lost by 12 ° and 13 °, respectively, and the bone grafts were fractured. Subtotal total splenectomy A way reconstruction of the sagittal Cobb angle no loss, fusion and no bone graft fracture and sink. Conclusion: There are few cases in this group, but initially we can see that ASP and AMP are the strong reconstruction methods after total spondylectomy, which can make the fusion of bone graft smoothly and prevent the loss of Cobb angle. However, ASP can reduce the fixed segment, to retain the movement unit, is a better way to fix. SP and A should not be used alone for stability reconstruction after total spondylotomy.