Krepler P, Windhager R, Toma C D, Kitz K, Kotz R
Department of Orthopaedic Surgery, University of Vienna, Medical School, Währinger Gürtel 18-20, Vienna 1090, Austria.
Spine (Phila Pa 1976). 2003 Sep 1;28(17):E334-8. doi: 10.1097/01.BRS.0000090504.32585.AC.
Resection of a primary malignant tumor of the bone with wide surgical margins has become the golden standard in oncological surgery. In the case of a spinal tumor with tumor invasion of the spinal canal, a wide resection could necessitate resection and subsequent replacement of part of the dura.
Dura replacement is a consequent surgical step in the treatment of primary malignant tumors of the spine.
We present the case of a 27-year-old male with a tumor of the dorsal elements of D6. After paraplegic symptoms, a laminectomy of D5 to D7 was performed and histologic examination revealed the presence of an osteosarcoma. After neoadjuvant polychemotherapy, a wide resection of the dorsal elements from D4 to D7 combined with a resection of the dorsal part of the dura was planned. Replacement of the dura was performed with Lyodura (B. Braun Melsungen AG, Melsungen, Germany). The spine was stabilized with an ISOLA instrumentation (Depuy International Ltd., Leeds, England). For wound closure, a pedicled latissimus dorsi flap and split skin graft were necessary. In a second step, ventral spondylodesis with Texas Scottish Rite Hospital instrumentation (Sofamor Danek, Memphis, TN) was performed.
One hundred sixteen months after surgery the patient is alive without evidence of disease, is pain free, and has returned to his profession and life without any restrictions.
采用具有广泛手术切缘的方式切除原发性骨恶性肿瘤已成为肿瘤外科手术的金标准。对于肿瘤侵犯椎管的脊柱肿瘤，广泛切除可能需要切除并随后置换部分硬脑膜。
硬脑膜置换是脊柱原发性恶性肿瘤治疗中必然采取的手术步骤。
我们报告一例27岁男性，其D6椎体后部存在肿瘤。出现截瘫症状后，对D5至D7进行了椎板切除术，组织学检查显示为骨肉瘤。新辅助多药化疗后，计划对D4至D7的椎体后部进行广泛切除，并切除硬脑膜的背部部分。用Lyodura（德国梅尔松根市贝朗医疗公司）置换硬脑膜。采用ISOLA内固定器械（英国利兹市迪普伊国际有限公司）对脊柱进行固定。伤口闭合需要带蒂背阔肌皮瓣和中厚皮片移植。第二步，采用德克萨斯州苏格兰 rite 医院内固定器械（美国田纳西州孟菲斯市索法莫·丹内克公司）进行前路脊柱融合术。
术后116个月，患者存活，无疾病迹象，无痛，已恢复工作和生活，无任何限制。
