欢迎来到天天文库
浏览记录
ID:34556818
大小:604.64 KB
页数:7页
时间:2019-03-07
《改良全脊椎切除技术后路一期切除胸椎肿瘤》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、万方数据生堡置科盘壶垫!Q生』旦筮30毪勇&』期£h也』蛳b哩,丛g里_201_0,yQ!:3Q:△b』·449-·I临床论著·改良全脊椎切除技术后路一期切除胸椎肿瘤郭常安阎作勤张键董健姜晓幸费琴明周晓岗蒋淳陈峥嵘【摘要】目的探讨改良全脊椎切除技术经后路一期切除胸椎肿瘤的可操作性和安会性。方法自主研制了系列经后路一期会椎体切除手术器械,包括:新型线锯切割器、椎间盘开口器、线锯导引钳和挡板拉钩,将Tomita提出的由前向后全脊椎切除“一步切割法”改良为由内向外“两步切割法”,即:先利用椎问盘开u器由脊柱后方、经硬膜和椎体间隙斜行由椎问盘水平向前方穿刺
2、,穿刺至挡板拉钩后,抽出穿刺针。将自制线锯由椎间盘开口器套筒内穿过,利用线锯导引钳将线锯由同侧导出,由内向外完成对一侧椎间盘的切割,同样完成邻位椎间盘的切割,上该侧脊柱固定棒,同法完成对侧两个椎间盘的切割。利用该改良全椎体切除技术对5例胸椎肿瘤进行了经后路一期全椎体切除的临床应用研究。5例患者分别为:骨母细胞瘤l例,骨巨细胞瘤2例,恶性血管瘤l例,前列腺癌骨转移l例。结果5例患者术后神经症状无加重,3例有明显改善,平均手术时间7.6h,平均术中出血量1750ml,无硬膜破裂和脑脊液漏发生。术后平均随访18.2(10~35)个月,截止到随访结束均无复
3、发。结论应用改良全脊椎切除技术经后路一期切除胸椎肿瘤在技术上是可行的,其可操作性和安全性较传统的Tomita全椎体切除术有明显提高。【关键词】胸椎;脊椎肿瘤;外科手术;治疗结果【证据等级】治疗性研究Ⅳ级ModifiedtotalenblocspondylectomyforthoracicvertebratumorthroughsingleposteriorapproachGUOChang-an,YANZuo·qin,ZHANGJmn,et以DepartmentofOrthopaedicSurgery,ZhongshanHospital,FudanU
4、niversity,Shanghai200032,China【Abstract】0bjectiveToinvestigatethepracticabilityands小tyofmodifiedtotalenblocspondylectomyrMTES).MethodsWehaddesignedaseriesofnovelsurgicalinstrumentsforMTESinde.pendently,includingsawcutter,discpunctureneedlewithsleeve,thesawleadingclampandprotec
5、tingre—tractor.ThetraditionaltotalenblocspondylectomyffES).whichwasreportedbyTomitawith”onestepdis-section”fromanteriorlytoposteriody.WaSmodtriedinto”twostepdissection”frommediallytoexteriorly.Firsdy.thedesiredcuttingdiscWaspuncturedthroughtlleplanebetweenduramaterspinalisandd
6、iscobliquelywith45。—60。tohorizontalplanebyusingthediscpunctureneedlewithsleeveinposterior-anteriordirection.Theneedleanditssleevewerestoppedbytheprotectingretractor,andthentheneedlewaspulledoutandasawwasinsertedthrou小theleftsleeve.Thetipoftheinsertedsawwasledouttothesamesideby
7、theleadingclamp.7IhediscWtjkScutbysawfrommediallytoexteriorly.Theneighboringdiscwascutthroughsameprocedure.Afteraspinefixationrodwasappliedonthisside,theresidualdiscsontheoppo-sitesidewerecutaspreviouslydescribed.FivepatientswiththoracicvertebratumorweretreatedbyusingMTEStechn
8、iquethroughasingleposteriorapproach.Theetiologyofthe5patients
此文档下载收益归作者所有