12casesofthoracictumorontheposteriorfullspineresectionandreconstructionofspinalstabil

1、12 cases of thoracic tumor on the posteriorfull spine resection and reconstruction ofspinal stabilityKeywords:thoracicspine tumors,spine/surgery,fixed0IntroductionThoracictumorsoftenleadtospinal cord compressionsymptoms, highmorbidityandmortality. Surgical resection of the tumor tissue, the liftingo

2、f oppression,alleviateneurologicalsymptomsistoimprovethequalityoflife andtheprimarymeansofsurvival. Thoracic special anatomical location, the front ofsternumandmediastinalblockedbehindtheshoulderbladetoblock,isdeep,revealextremelydifficult1.hospital200506/200705usingthemidlineapproachspine resection

3、 for thoracic tumors in 12 cases to obtain satisfactory results.1 clinicaldataThisgroupof patients12 (9maleandfemale3cases,age38to66(average56-year-old lesion: T3 1 case 1 cases of T4, T5, 3 cases ofT7 in 2 cases, theT8 5 cases of tumortypes:myelomacases,giantcelltumorofthreecases,twocasesof1hemangi

4、oma,6casesofmetastatictumors.8casesofchestandback pain as the mainclinicalmanifestations,four cases of lower extremity weakness, gait damage themaincomplaint.pathologicalsegmenthypoesthesia11cases,thepathologicalpositiveof sevencases,MRIofvertebralcompression,kyphosis,andduralsaccompression.patients

5、weretreatedwithgeneralanesthesiaintubationintheproneposition,posteriormidline incision, exposure of the upper and lower vertebra2laminaofthetransverseprocessoftheremovalofdiseasedvertebraerevealedriband3to 4 cm in fromSternocostal joint cut off, the removal of the rib head, neck.pleuralsincetheblunt

6、dissectionofbothsides ofthevertebralbody,clean-upthe foraminalwillintercostalartery into the side to remove the spinous process, laminaand articular process were placed in two pedicle screw upand down the vertebra, and the CD HORIZON M8 or SINAorRSSconnectingrodaccordingtothespinalphysiologicalcurve

7、pre-bentinadvanceofinstalltheunstablesideoftheconnectingrod,topreventtheremoval of vertebralspineinstabilityalongthevertebrainferiorendplate,respectively,removalofthe disc and2posteriorlongitudinalligament.bluntseparationofthepedicle is relatively intact side of the pleura, pushed duralsac,ipsilater

8、alpedicleandvertebralbody.otherside ofthelinepediclepre-fixed,theestablishmentofthetemporarystabilityofthespine,removethefirstinstallationsideoftheconnectingrods,removaloftheremaining vertebral and intervertebral disc and vertebraljoin the body in front of carefully wash the surgical field toconfirm

9、theperipheralnon-residualtumortissue,theappropriate length of the titanium mesh and autogenousboneorcementcomplexoftitaniumrodsimplantedtoadjust the connecting rod pressure to complete the frontof the structure reconstruction of the spine. postoperativelyingis hardBanchuang,2 weeksaftersutureremoval

10、,dependingonthedegreeofnervedamageinpatients,allow patients to sit up or walk with 12 cases patients werefollowedup3 to23 (mean10mo.sevencasesof spinalcordfunctionfullyrestored,chestandbackpaindisappearedcompletely.threecasesoflowerlimbweaknessandgaitimpairmentbetterrecovery,sensoryrecovery is slow,

11、 especially numbness after surgery at 3, 6,and 12 mo review of X-ray film, see the vertebral height3restoration sequence intact vertebral bone fusion. 8 mo death, two cases of metastatic cancer patients.2DiscussionPreviousthoracictumortreatmentwithradiationandchemotherapy,butwhenpathologicalfracture

12、s,spinalinstability,spinalcordcompressionand pain,difficulttotreat.Inrecentyears,withtherapiddevelopmentofthethoracicfixationtechniques,surgicaltreatmentgraduallyinthethoracicoccupiesaspecialplaceinthetreatmentof tumors 2.Tomita,etal.3thattheisolatedposteriorvertebralresection to minimize the recurr

13、ence rate of spinal tumors,and significantly improve the survival of the whole spineexcision can completely remove the spinal cord caused bypressure of the circumference, and pedicle screw fixationcannotonly providethestability of thespine vertebraefull cut, and in the vertebral body reconstruction

14、processtofullpressure,soastosolvethethoracictumormorbidity and mortality. summary of this group, 12 casesof clinicalmedicalrecords,webelievethattheposteriorfull spine excision and vertebral body reconstruction, withthe following advantages: a single approach to achieve4the minimally invasive removal

15、 of the lamina, pedicle andvertebralbody;rigidinternalfixationandearlyfunctionalexercise; operatingsmoothly,savingtime; lookdirectlyattheoperationtoreduce interferencewith thespinalcord,nerves,chestand otherimportantstructures; alternatelysinglerodpre-fixedstabilitytoprovidesurgeryofthespine.reducet

16、hepossibilityof aspinalcordinjury; The one-timecompletionofthevertebralbodyresectionandstabilityofthereconstruction. Share the free paperthoracictumorsurgeryhasbeenthefocusofdiscussionweWebelievethattheposteriorapproachspine surgery to remove for the cases of tumor invasion ofthe entire vertebral bo

17、dy. full corpectomy inevitably leavea largerbonestructuredefects,especiallythe discandarticularresectionofthe vertebralsequencecompletelyinterruptspinal cordinthecircumferenceofthe“vacant ”, the spine is no stability at all. tumor invasion ofthe canal volume is smaller, the spinal cord to escape spa

18、ce decreases, the more limited operative space, therefore must keep the spine stable during surgery in order to reduce the medical derived spinal cord injury in5practice, we advocate alternately single rod pre-fixed, sothat not only the operation of space security, and stabilityof the spine is always maintained. and then to rebuild thefront of the structure of autologous bone, titanium mesh,bone cement,pedicle pressurizingtherootsystem,andpromote bone healing, the completion of the permanentreconstructionof spinalstability.seethis group