Local wide excision of anterior vertebral tumor

Children's bone tumors include primary and secondary bone tumors. Primary bone tumors refer to benign bone tumors, malignant bone tumors and tumor-like lesions originating from bone tissue. Secondary bone tumors refer to other organ malignant tumors. A tumor of bone tissue. Clinically, benign bone tumors and tumor-like lesions are more common. Among malignant bone tumors, osteosarcoma is the most common. In recent years, due to the advancement of surgical techniques, the establishment of surgical system of bone tumor surgery and the extensive application of adjuvant chemotherapy before and after surgery have significantly improved the surgical treatment of bone tumors. The 2-year tumor-free survival rate has increased from 30% to 80%. Moreover, amputation is no longer the first choice for the treatment of malignant bone tumors. Many scholars advocate the use of local extensive or local radical bone tumor resection and limb preservation surgery, that is, surgical removal of tumor lesions, and the use of adjuvant chemotherapy to eliminate the occurrence of Microscopic metastatic lesions. According to the degree of malignancy of the tumor, the location and extent of the involvement, anterior and posterior approaches can be used. Anterior surgery is ideal for vertebral tumor resection, spinal canal decompression and spinal fixation; sometimes it is necessary to perform anterior and posterior approaches simultaneously to achieve complete resection of the tumor; posterior surgery is suitable for the tumor located at the posterior edge of the vertebral body, because The damage is small, the bleeding is small, and it has certain advantages. Treatment of diseases: lumbar spondylosis giant cell tumor of bone Indication Local extensive resection of anterior vertebral tumors is applicable to: 1. Thoracic or lumbar spine single malignant tumor or metastatic tumor. 2. Giant cell tumor of the thoracic or lumbar spine or a neurogenic tumor that erodes the vertebral body. Preoperative preparation 1. CT and MRI examination to determine the extent of bone tumor involvement. 2. Chest X-ray and whole body radionuclide bone scan, except for lung metastasis and bone metastasis. 3. Biopsy clear pathological diagnosis. 4. Those who have the condition, the tumor vertebral body embolization 1d before surgery can significantly reduce intraoperative bleeding. 5. Prepare blood for more than 1000ml. Surgical procedure Incision Different surgical incision approaches are used depending on the affected vertebral body. T412 patients were treated with thoracotomy; T12L2 patients underwent transthoracic and retroperitoneal approach; those below L2 were treated with renal incision. 2. Reveal In the thoracic vertebrae, after longitudinal incision of the wall pleura, the paravertebral loose tissue is separated forward and backward, paying attention to the frontal line of the vertebral body, mainly to reveal the corresponding rib head backwards; in the lumbar vertebrae, the separation of the psoas muscle surface should be performed. Retracted from the leading edge of the psoas muscle to the posterior side. The vertebral body of the lesion and the normal vertebral body of the upper and lower borders are then further revealed, and if necessary, positioned under fluoroscopy. The segmental blood vessels on the lateral side of the diseased vertebral body are separated, cut and ligated. 3. Tumor vertebral body resection The location of the tumor vertebral body is further determined under fluoroscopy. The pedicle of the affected side is removed first, and then separated along the lateral direction of the vertebral body. After the rib head is removed, the posterior edge of the vertebral body, the intervertebral foramen, the pedicle and the transverse process are revealed, and the affected vertebrae are bitten with a lancet. Bow root. Then the disc is removed, the upper and lower intervertebral discs of the vertebral body are removed with a scalpel, and the cartilage plate is removed with a bone knife until the endplate cortical bone is revealed. The vertebral body was pushed forward with a periosteal stripper to reveal the gap in front of the dura mater, and the contralateral pedicle was cut with the osteotome through the posterior aspect of the vertebral body. Then use a rongeur to gradually bite the posterior wall of the vertebral body. 4. Vertebral fixation and reconstruction After the tumor vertebral body is removed, the upper and lower normal vertebral bodies are separated by a spreader, and then the vertebral body nail or the Armstrong fixed plate is placed. A depression of about 1 cm deep is cut in the surface of the upper and lower vertebral bodies, and the autogenous iliac bone block is embedded, and the cancellous bone strip is further filled in front of the vertebral body; a bone cement filling method can also be used. 5. Close the incision After washing with saline, the wall pleura should be carefully sutured in the thoracic segment. If the pleura is closed, the deep fascia near the incision can be used to repair the drainage tube. In the thoracolumbar region, the diaphragm should be carefully sutured; A vacuum suction tube should be placed in the retroperitoneal space. Then close the incision layer by layer.