Objectives To investigate the surgical results of one-stage total en bloc spondylectomy (TES) and reconstruction via a single posterior approach for thoracic symptomatic vertebral hemangioma associated with spinal cord dysfunction and evaluate its curative effect. Methods A total of 9 patients treated with one-stage TES ( 7 cases ) and total vertebrectomy ( 2 cases ) by posterior approach from March 2006 to January 2010 were retrospectively reviewed.The cases included 2 males and 7 females with a median age of 33.6 years ( range 14 to 77 years),and with 1 case of Grade A,3 cases of Grade B,3 cases of Grade C,2 cases of Grade D according to Frankel grade system.All patients suffered from moderate to severe pain and neurological deficit with an average symptom duration of 14.4 months ( range 3-24 months) MRI revealed severe spinal cord compression.The spinal reconstruction was obtained by titanium mesh filled with autograft and posterior internal fixation with rod-screw system. Results The operation time was 210 minutes on average (180-270 minutes) and the average blood loss was 1800 ml (1000-5000 ml).The follow-up period lasted from 18 months to 5 years. All cases with preoperative pain relieved after operation. The visual analogue scale pain scores decreased to 1.1 from 8.3 at 3 months after surgery. No disruption of dural mater,cerebrospinal fluid leakage,iatrogenic spinal cord injury and major vessel damage occurred.Up to now,there was no local recurrence in all cases.Significant neurological function improvement was achieved in all patients with one to three grades in Frankel grade system.Fusion of the autograft was well achieved and no internal fixation failure in all patients.Conclusions One-stage TES and spine reconstruction by a single posterior approach is fcasible, safe and effective to this discasc. It is favourable in decreasing the hemangioma recurrence and improvement of the neurological function.%目的 探讨一期后路全脊椎整块切除术治疗胸椎症状性血管瘤合并脊髓功能障碍的疗效及其应用价值.方法 2006年3月至2010年1月收治胸椎症状性血管瘤伴不同程度脊髓功能障碍患者9例,男性2例,女性7例,年龄14～ 77岁,平均33.6岁.患者均有不同程度的胸背部疼痛与下肢无力、行走困难.病程3个月至2年,平均14.4个月.患者均为单椎体受累.术前脊髓功能Frankel分级:A级1例,B级3例,C级3例,D级2例,均行一期后路全脊椎(7例)或全椎体(2例)整块切除,同时采用钛网或人工椎体植骨前方重建,联合应用椎弓根螺钉系统内固定.观测术中出血量、术后局部疼痛和脊髓功能恢复情况,以及肿瘤复发、植骨融合、脊柱稳定性情况.结果 9例患者均顺利完成手术,手术时间180～ 270 min,平均210 min；失血量1000 ～5000 ml,平均1800 ml.随访18个月至5年,平均21个月.术前视觉模拟评分平均8.3分,术后3个月平均1.1分,平均下降7.2分；神经症状不同程度恢复或改善,l例患者Frankel分级由术前A级恢复至C级,其余均恢复至E级.末次随访时所有病例无局部复发,植骨融合良好,无钛网移位及脊柱失稳,无内固定钉棒松动断裂迹象.结论 一期后路全脊椎整块切除术治疗胸椎症状性血管瘤合并脊髓功能障碍疗效可靠,是一种可显著改善脊髓神经功能,预防肿瘤局部复发,改善患者生存质量的有效术式.
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