脊椎肿瘤的外科治疗

目的：探讨采用不同经路切除脊椎肿瘤与改进的人工椎体和自体植骨术治疗脊椎不同节段肿瘤的疗效。方法：对13例脊椎肿瘤采取切除瘤椎、人工椎体置换和自体植骨术；肿瘤包括颈椎4例,胸椎3例，腰椎6例。术前颈脊髓瘫痪1例，不完全瘫痪4例，肿瘤的术后病理学诊断有骨巨细胞瘤3例，骨囊肿、Ewing瘤、骨神经鞘瘤、软骨瘤、骨成纤维细胞瘤、骨纤维细胞瘤、骨嗜酸性肉芽肿、骨转移瘤、骨肉瘤和骨血管瘤各1例。结果：13例安全度过围手术期，无脊髓神经症状加重。除1例3个月恢复良好后失访外，余12例获平均4．3年随访，瘫痪5例完全恢复，12例均恢复家务和工作，X线片显示假体无松动、移位，植骨融合。结论：应根据肿瘤的脊柱节段和类型，选择手术治疗方式，采用人工椎体置换和自体植骨术，对完全切除脊椎肿瘤和重建脊椎稳定性是十分有益的。

The Surgical Treatment of the Spinal Tumors

Objective:To research the results of the patients with spinal benign or malignant tumor in the spine treated with artificial vertebral body replacement and auto bone grafting through anterior or/and posterior approach.Methods:Thirteen cases with the benign and malignant tumors were treated by artificial vertebral body replacment and autobone grafting to restore the spinal stabilization.The tumors involved the cervical vertebrae in 4 patients,the thoracic vertebrae in 3,the lumbar vertebrae in 6.Among three patients vertebral tumors involved the posterior elements of vertebrae.Complete paraplegia was in one case,and incomplete paraplegia were in 4.In this sieres,the pathological diagnosis were included bone giant cell tumor in 3 patients,and bone cyst,Ewing's sarcoma,neurilemmoma,eosinophilic granuloma of bone,spinal hemangioma and metastatic carcinoma of vertebrae in each one.Results:All patients stood surgery well.Except one lost follow up in 3 monthes after surgery.Twelve patients were followed up for 4 years and 4 monthes in average. Every case had followed up with radiograph,neurologic function and no loosened and displacement.They recovered completely from spinal cord paralysis and restored a normal home work and daily life.The stabilization between the spine and prothesis were excellent.Conclusion:The surgical treatment of the spinal tumors must be decided in according with the spinal segment and types of tumors,Artificial vertebral body replacement and auto bone grafting for the patients with spinal tumors are required for adequate tumor removal and stabilization of the spinal colum reconstruction.