颈椎肿瘤资料.doc

全脊椎切除术治疗脊柱肿瘤及稳定性重建前言：目的 :探讨全脊椎切除、融合及稳定性重建术在治疗全脊椎肿瘤中的必要性和可行性。方法 :对 11例全脊椎肿瘤的患者行后路或联合前、后路期全脊椎切除、脊髓减压 ,并进行椎间植骨融及后路植骨融合、固定的手术。结果 :术后随访 3个月 2年 ,7例神经功能丧失者,6例完全恢复,1例部分恢复 ,所有患者局部疼痛皆消失。 1例术后出现一过性瘫痪加重。术后平均植骨融合时间为 3个月。 1例神经鞘瘤患者1年后复发并恶变。结论 :颈部全脊椎肿瘤 ,联合前、后路手术 (肿瘤切除、植骨、内固定 )可以彻底切除全脊椎肿瘤及稳定性重建 ;对胸、腰段脊椎肿瘤仅行后路手术便可彻底切除全脊椎肿瘤 ,并通过植骨及椎弓根钉系统内固定重建脊柱的稳定性THE STUDY OF VERTEBRECTOMY FOR TREATMENT OF SPINAL TUMORS AND SPINE RECONSTRUCTION;Objective:To explore the feasibility of vertebrectomy and fusion for treatment of spinal tumors and spine reconstruction.Methods:Eleven cases of spinal tumors were performed this operation from 1997,followed by posterior apporach,or anterior and posterior apporach.Results:The follow up of postoperation was from 3 months to 2 years.All patients were free.from rain six of 7 neural dysfuntion reeovered completely.Only 1 case were temporay paralysis.All the cases had solid fusion at an average of 3 months.The .KeywordsSpine rconstruction;Spinal neoplasms;Vertebrectomy前后路联合一期全椎体切除脊柱重建治疗胸腰椎恶性肿瘤（博士论文）前言：目的探讨前后路联合一期全椎体切除脊柱重建治疗胸腰椎肿瘤的疗效及优越性。方法应用前路全椎体切除、钛网植骨或钛网骨水泥椎体重建和后路椎弓根钉系统内固定治疗胸腰椎恶性肿瘤24例。结果术后随访935个月。所有患者疼痛症状均消除,9例不完全截瘫患者平均恢复1。8级(Frankel分级),2例大小便功能障碍者均恢复,4例远处重要脏器转移死亡,所有随访达69个月的病例均骨性融合,无内固定松动断裂,1例术后1年复发。结论前后路联合一期全椎体切除脊柱重建治疗胸腰椎恶性肿瘤能有效切除肿瘤、重建脊柱稳定性、提高病人生活质量。Treatment of thoracolumbar malignant neoplasms by one stage anterior-posterior approach total spondylectomy and spinal reconstraction;ObjectiveTo study the curative effect and superiority of one stage anterior-posterior approach total spondylectomy and spinal reconstraction in the treatment of thoracolumbar malignant neoplasms.MethodTwenty-four thoracolumbar malignant neoplasms patients treated by anterior approach total spondylectomy,spinal reconstractin with titanium mesh cage associated with bone graft or bone cement and posterior approach transpediuclar screw fixation.ResultThe follow-up of postoperation was from 9 to 35 months.Key words: thoracolumbar;spinal neoplasms;titanium mesh cage;bone graft;bone cement;internal fixators;reconstruction前后联合入路一期全脊椎切除脊柱重建治疗颈胸交接部脊椎肿瘤前言：目的探讨颈胸交接部脊椎肿瘤通过前后联合入路一期全椎切除脊柱重建治疗的可行性。方法对8例颈胸交接部脊椎肿瘤选用改良的颈胸交接部前方入路及传统后方入路,一期行病椎全椎切除,脊柱重建方法。结果术后1个月,除1例T2血管瘤神经功能A级恢复至C级,其余患者为E级(3例E级术后未加重)。结论选用改良的颈胸交接部前方入路及传统后方入路,一期行病椎全椎切除、椎体间植骨、前后联合固定重建脊柱,为治疗颈胸交接部脊椎肿瘤的一种可行方法。经后路一期全脊椎切除治疗胸椎单脊椎肿瘤的临床疗效(博士论文)前言：目的探讨胸椎单脊椎肿瘤通过后路一期病椎切除、单纯植骨支撑融合或钛网支撑植骨融合、后路椎弓根钉系统内固定,达到切除病灶并同时重建脊柱稳定性的可行性。方法对18例胸椎单脊椎肿瘤患者行后路一期全脊椎切除、环脊髓减压,同时进行后路单纯植骨融合或椎间钛网支撑植骨,应用后路CD、TSRH或Scofix椎弓根钉系统内固定。男3例,女15例;年龄1458岁,平均23岁。T41例,T51例,T62例,T84例,T93例,T104例,T112例,T121例。病理诊断:动脉瘤样骨囊肿4例,血管瘤2例,骨母细胞瘤2例,神经鞘瘤1例,骨巨细胞瘤5例,单发骨髓瘤1例,转移瘤3例。术前Frankel分级:A级6例,B级7例,C级3例,E级2例。结果术后随访3个月2年,16例脊髓功能障碍者,12例完全恢复,4例部分恢复,所有患者局部疼痛均消失。1例术后出现一过性瘫痪加重,1例出现脊椎滑脱。术后平均植骨融合时间为3个月。1例骨巨细胞瘤患者复发;1例神经鞘瘤患者1年后局部出现包块,取活检报告为恶性肿瘤(未报组织学类型),4个月后死亡;1例肺癌转移患者术后6个月死亡;其余病例存活至今。结论对于胸段脊椎肿瘤行后路手术可一期实施单。Posterior approach to radical resection for thoracic tumor and spine stabilization and reconstruc-tion in one stage;Objective To discuss total vertebrectomy and spine stability and reconstruction by pos-terior ap proach for thoracic vertebra tumor and pedicle screw system fixation and intervertebral fusion.Methods Eighteen patients of 3males and15females of thoracic total vertebral tumor were operated in this group.The age of the group were from14to58years old,with the average of 23years.There were4aneurysmal bone cysts,2hemangiomas,2osteoblastomas,1neurilemomas,5giant cell tumor,1solitary myeloma and3metastati.KeywordsThoracic vertebrae;Neoplasms;Orthopedic procedures;Treatment outcome;侧方途径切除胸腰椎肿瘤和脊柱重建前言：目的探讨侧方入路手术途径切除胸腰椎肿瘤和重建脊柱稳定性的临床疗效和意义。方法 2 9例T3 L4肿瘤患者 ,Frankel神经功能分级 :A级 3例 ,B级 5例 ,C级 7例 ,D级 6例 ,E级 8例。经侧方入路手术途径显露病椎前方、侧方和后方 ,切除肿瘤以及上下相邻椎间盘 ,然后根据肿瘤的具体情况进行不同形式的脊柱稳定性的重建。结果围手术期无死亡病例 ,患者出院时Frankel神经功能分级 ,A级 2例 ,B级 3例 ,C级 4例 ,D级 4例 ,E级 16例。术后获访 2 3例 ,随访时间 13 5 8个月 ,死亡 4例 ;神经功能情况 ,13例较出院时有改善 ,加重 1例。结论侧方入路手术途径无需经胸 /腹膜腔 ,患者容易耐受手术 ,适合于某些胸腰椎肿瘤的切除和脊柱稳定性的重建。Resection of thoracolumbar vertebral neoplasm and spine reconstruction via lateral approach;Objective To investigate the clinical result of thoracolumbar vertebral neoplasm resection and spine reconstruction via lateral approach. Methods 29 cases of thoracolumbar neoplasm, from T 3 to L 4, were enrolled. Neurological status was determined by Frankel grades: Grade A:3, Grade B:5, Grade C:7, Grade D:6 and Grade E:8. The anterior, posterior and lateral aspects of morbid vertebrae were exposed via lateral approach, then the neoplasms were resected, finally the spines were reconstructed differ.spinal neoplasms;spinal fusion;脊椎肿瘤的外科治疗前言：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 ,植骨融合良好。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.脊柱重建手术对胸腰椎转移瘤致脊髓功能障碍及疼痛的改善作用前言：目的通过评价脊柱重建方法,探讨手术治疗脊柱转移瘤缓解患者的顽固性疼痛及恢复运动功能和脊柱稳定性的可行性。方法对18例胸腰椎转移肿瘤分别采用前路,后路及前后路联合肿瘤病灶切除加人工椎体替代物辅助器械内固定稳定手术,术后配合相应放、化疗,平均随访18个月(648个月)。结果18例患者手术前疼痛评分为7。02。3,手术后疼痛评分为3。02。6。其中14例患者(88