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目的探讨胸椎骨肿瘤后外侧入路全脊椎切除方式、重建技术及其疗效。方法25例胸椎骨肿瘤患者实施后外侧入路全脊椎切除重建术。经胸椎后外侧入路行单椎节切除22例、双椎节切除3例,均采用Harms钛网植骨/钛网骨水泥联合TSRH/MOSS/CDHM8椎弓根钉内固定系统重建。结果随访3个月~6年,23例术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解;21例脊髓神经功能完全恢复;1例术后出现一过性瘫痪加重;3例分别于术后1~3年局部复发;术后12和18个月各死亡1例。结论胸椎后外侧入路全脊椎切除能显著降低胸椎骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。钛网植骨/钛网骨水泥联合椎弓根螺钉系统能有效重建脊柱的前后柱稳定,同时具有减少创伤、缩短手术时间、降低并发症的优势。
Objective To investigate the total vertebra resection and reconstruction technique and its curative effect in posterolateral approach of thoracic vertebrae. Methods 25 patients with thoracic vertebral tumors underwent posterolateral approach total spinal resection and reconstruction. Twenty-two cases of unilateral vertebral resection and two cases of double vertebral excision were performed through the posterolateral thoracic approach. All of them were reconstructed with Harms titanium mesh/titanium mesh cement combined with TSRH/MOSS/CDHM8 pedicle screw fixation system. Results The follow-up period was 3 months to 6 years. The short-term curative effect was satisfactory in 23 cases. Local pain and neurological symptoms were improved or relieved in different degrees. In 21 cases, the spinal nerve function was completely recovered; 1 case showed transient aggravation after surgery. Three cases recurred locally within 1 to 3 years after operation and 1 died after 12 and 18 months. Conclusion The total posterior thoracic spinal excision can significantly reduce the local recurrence rate of thoracic bone tumors, improve spinal nerve function, and improve the curative effect. Titanium mesh bone graft/titanium mesh bone cement combined with pedicle screw system can effectively reconstruct the stability of the spine column. It also has the advantages of reducing trauma, shortening operation time, and reducing complications.