目的:评价胸腰椎肿瘤整块切除和前柱重建术的围手术期临床疗效。
方法:本研究对86例连续患者的前瞻性数据收集进行了回顾性分析,包括40名男性和46名女性,平均年龄为39岁(10至71岁)。原发性恶性肿瘤35例,42例侵袭性良性肿瘤,和9例转移。病灶主要位于胸椎65例,腰椎17例,胸腰椎4例。45名患者的肿瘤涉及一个级别,12名患者的两个水平,21名患者的三个级别,五个病人的四个级别,两名患者的五个级别,一个病人有六个级别。
结果:根据Weinstein-Boriani-Biagini手术分期系统,所有患者都实现了整体切除,其中全脊椎整块切除74例,矢状面切除12例。平均手术时间为559分钟(210-1208分钟),平均总失血量为1528ml(260-5500ml)。62例(72.1%)患者共观察到122例并发症,其中18例(20.9%)患者出现25种主要并发症,1例(1.2%)患者死于并发症。组合方法(P=0.002),总失血量(P=0.003),分期手术(P=0.004),既往手术史(P=0.045),受累椎体数量(P=0.021)和腰椎位置(P=0.012)是主要并发症的显著危险因素。当上述所有危险因素纳入多变量分析时,只有联合治疗(P=0.052)仍然显著.
结论:整块切除和前柱重建术伴随着较高的并发症发生率,特别是当一个联合的方法是必要的。
OBJECTIVE: To evaluate the perioperative clinical outcomes of en bloc resection and anterior column reconstruction for thoracolumbar spinal tumors.
METHODS: This study conducted a retrospective analysis of prospective data collection of 86 consecutive patients, including 40 males and 46 females, with an average age of 39 years (ranged from 10 to 71 years). There were 35 cases of a malignant primary tumor,42 cases of an aggressive benign tumor, and nine cases of metastases. The main lesions were located in 65 cases of thoracic spine, 17 cases of lumbar spine, and 4 cases of thoracolumbar spine. Tumors involved one level in 45 patients, two levels in 12 patients, three levels in 21 patients, four levels in five patients, five levels in two patients, and six levels in one patient.
RESULTS: According to the Weinstein-Boriani-Biagini surgical staging system, all patients achieved en bloc resections, including 74 cases of total en bloc spondylectomy and 12 cases of sagittal resections. The mean surgical time was 559 min (210-1208 min), and the mean total blood loss was 1528 ml (260-5500 ml). A total of 122 complications were observed in 62(72.1%) patients, of which 18(20.9%) patients had 25 major complications and one patient (1.2%) died of complications. The combined approach (P = 0.002), total blood loss (P = 0.003), staged surgery (P = 0.004), previous surgical history (P = 0.045), the number of involved vertebrae (P = 0.021) and lumbar location (P = 0.012) were statistically significant risk factors for major complication. When all above risk factors were incorporated in multivariate analysis, only the combined approach (P = 0.052) still remained significant.
CONCLUSIONS: En bloc resection and anterior column reconstruction is accompanied by a high incidence of complications, especially when a combined approach is necessary.