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钱明,孔金海,钟南哲,肖辉,孙正望,赵剑,杨兴海,肖建如.一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤[J].脊柱外科杂志,2017,15(2):100-105.
一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤     点此下载全文 (Fulltext)
钱明1  孔金海1  钟南哲1  肖辉2  孙正望1  赵剑1  杨兴海1  肖建如1
1. 第二军医大学附属长征医院骨肿瘤科, 上海 200003;
2. 中国人民解放军第474医院骨科, 新疆维吾尔自治区 830013
基金项目:
DOI:10.3969/j.issn.1672-2957.2017.02.007
摘要点击次数: 64
全文下载次数: 9
摘要:
      目的 探讨一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤的临床疗效。方法 2011 年8 月-2012 年8 月第二军医大学附属长征医院骨肿瘤科共收治5 例枢椎孤立性浆细胞瘤患者,Frankel 分级B 级1 例,C 级1例,E级3 例;Tomita 分型Ⅱ型1 例,Ⅲ型1 例,Ⅳ型3 例;均行一期前后联合入路全脊椎切除术,采用前路钛网并后路椎弓根钉棒系统固定即刻重建上颈椎稳定性。对所有患者的病史、手术前后影像学资料、手术时间、出血量、手术并发症及临床疗效进行分析。结果 所有患者随访6-48 个月,平均33.2 个月;手术时间320-480 min,平均394 min;术中出血量600-2 500 mL,平均1 460 mL;术中无椎动脉或脊髓损伤、大出血或脑脊液漏等并发症发生。1 例患者术后出现肺不张,引起发热,经过盐酸氨溴索(沐舒坦)雾化吸入,拍背化痰,积极有效抗炎治疗后恢复。1 例糖尿病患者,术后皮肤切口愈合不良,二期清创后治愈。1 例患者术后出现反应性胸腔积液,给予积极对症治疗后好转。术后Frankel 分级B 级患者恢复至D级,C 级患者恢复至E 级,其余3 例神经功能仍保持E 级。所有患者术后均行辅助放疗2.5-3.0 个月,随访至今未见复发征象。结论 一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤安全、有效,可改善患者神经功能,其远期疗效有待进一步观察研究。
关键词:枢椎  浆细胞瘤  截骨术  内固定器  骨移植
Total spondylectomy via one-stage combined anterior and posterior approach for treatment of axial solitary plasmacytoma    Fulltext
QIAN Ming1  KONG Jin-hai1  ZHONG Nan-zhe1  XIAO Hui2  SUN Zheng-wang1  ZHAO Jian1  YANG Xing-hai1  XIAO Jian-ru1
1. Department of Bone Tumor, Changzheng Hospital, Secondary Military Medical University, Shanghai 200003, China;
2. Department of Orthopaedics, 474th Hospital of Chinese PLA, Urumqi 830013, Xinjiang Uyghur Autonomous Region, China
Fund Project:
Abstract:
      Objective To investigate the therapeutic effect of total spondylectomy via one-stage combined anterior and posterior approach for axial solitary plasmacytoma. Methods From August 2011 to August 2012, 5 patients with axial solitary plasmacytoma were treated in Changzheng Hospital. According to Frankel classification, 1 patient was grade B, 1 grade C and 3 were grade E. According Tomita typing, 1 patient was classed as type Ⅱ, 1 as type Ⅲ and 3 as type Ⅳ. Total spondylectomy via one-stage combined anterior and posterior approach was completed, and the stability of the upper cervical spines was reconstructed with titanium mesh in anterior approach, and pedicle screws in posterior approach synchronously. The clinical history, preoperative and postoperative imaging data, operation time, blood loss, complications and therapeutic effect were recorded and analyzed. Results All the patients were followed up for 6-48 months, mean 33.2 months. The operation time was 320-480 min, mean 394 min. The blood loss 600-2 500 mL, mean 1 460 mL. There were no complications as vertebral artery injury, spinal cord injury, hemorrhoea or cerebrospinal fluid leakage during the operative period. One patient suffered fever and pulmonary atelectasis, and recovered by inhalation, patting the back, eliminating phlegm, and active anti-inflammatory. Poor incision healing was seen 1 patient with diabetes mellitus, and healed by second debridement. One patient developed reactive pleural effusion after the surgery, which was improved by symptomatic treatment. The Frankel grade was recovered from B to D in 1 case, C to E in 1, and the other 3 cases remained at grade E. All the patients were treated by adjuvant radiotherapy for 2.5-3.0 months, and no recurrence was found. Conclusion Total spondylectomy via one-stage combined anterior and posterior approach for treatment of axial solitary plasmacytoma is safe and effective and can improve the neurological function, and its long-term efficacy needs to be further scrutinized and researched.
Keywords:Axis  Plasmacytoma  Osteotomy  Internal fixators  Bone transplantation
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