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目的:观察椎体前手术入路方法治疗上胸段脊柱椎体肿瘤的疗。方法:选择侵犯椎体的上胸段脊柱肿瘤21例。经前路切除肿瘤减压、植骨及前路钢板或钉棒系统固定,4例患者术中辅以局部氯甲蝶呤治疗。随访1～44个月。结果:21例患者均安全度过围手术期,1例术后发生乳糜漏;4例出现喉返神经牵拉伤所致—过性声音嘶哑;2例出现一过性膈神经刺激引起的呃逆症状。18例患者术后神经功能有不同程度改善,3例无明显改善。随访期间1例于1月后双侧肺炎死亡;2例局部复发;1例癌细胞全身转移死亡。均无断钉及内固定脱落。结论:对上胸段脊柱体椎肿瘤应用椎前入路手术,可直接暴露椎体肿瘤病变部位,肿瘤切除和椎管减压彻底,术后脊柱的稳定性恢复良好。
Objective: To observe the treatment of upper thoracic vertebral vertebral body tumor by anterior vertebral approach. Methods: Twenty-one cases of upper thoracic spinal tumors were selected to invade the vertebral body. Anterior resection of tumor decompression, bone grafting and anterior plate or nail system fixation, 4 patients assisted by local methotrexate treatment. Followed up for 1 to 44 months. Results: Twenty-one patients were perioperatively safe, one had postoperative chylothorax, four had recurrent recurrent laryngeal nerve injury, and had hoarseness. Two patients had hiccup caused by phrenic nerve stimulation symptom. The neurological function of 18 patients improved to some extent after operation, and no significant improvement was found in 3 patients. One patient died of bilateral pneumonia after one month; two patients had local recurrence; one patient died of systemic metastasis. No broken nails and internal fixation off. Conclusion: The application of anterior approach to upper thoracic spinal tumors can directly expose the lesion of vertebral body. The tumor resection and thorough decompression of spinal canal are completed. The stability of postoperative spine recovered well.