Czyz Marcin, Addae-Boateng Emmanuel, Boszczyk Bronek M
The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, D Floor, West Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
The Department of Cardiothoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Eur Spine J. 2015 Oct;24(10):2220-4. doi: 10.1007/s00586-015-4164-y. Epub 2015 Jul 29.
Technical note.
In cases in which partial resection of the rib cage is accomplished with vertebrectomy, reconstruction of the chest wall may be challenging. That is because of lack of the anchor point which normally would be a proximal end of a rib or transverse process. We report a straightforward technique for chest wall reconstruction with the novel use of two systems of fixation commonly applied in spinal practice.
The operation of a squamous cell carcinoma (Pancoast tumour) of the right lung infiltrating T2, T3 and T4 vertebrae was performed though T4 lateral thoracotomy. Posterior instrumentation with transpedicular screws T1-3-5 on the left and T1-5 on the right side was followed with the right upper lobectomy and hemivertebrectomy. The laminae and facet joints of T2-T4 vertebrae were removed on the side of the tumour. An osteotomy was performed medial to the pedicle at the lateral aspect of the dural sac on the side of the tumour. Proximal parts of four adjacent ribs were removed allowing radical en bloc resection with tumour-free margins. The distal end of each of four rib plates used (MatrixRib Precontoured Plate system) was attached to the proximal end of the rib. The proximal end of the plate was then attached to the rod of posterior fixation construct with the use of a flexible polyethylene terephthalate (PeT) band of the SILC™ fixation system. The other end of the PeT band was then passed through the top-loading clamp subsequently attached to the rod of the posterior fixation.
The patient did not require additional procedures for chest wall reconstruction. On the 7-month follow-up, in chest CT he was found with satisfactory expansion of the remaining lung tissue with proper spinal alignment and anatomical shape of the rib cage.
The reported technique can be applied for chest wall reconstruction in cases of total or subtotal vertebrectomy accomplished with the resection extending towards rib cage. It appears to be straightforward, safe and effective allowing good cosmetic and functional outcome.
技术说明。
在通过椎体切除术完成部分胸廓切除的病例中，胸壁重建可能具有挑战性。这是因为缺乏通常作为肋骨近端或横突的固定点。我们报告一种简单的技术，通过创新性地使用脊柱手术中常用的两种固定系统来进行胸壁重建。
通过T4外侧开胸术对侵犯T2、T3和T4椎体的右肺鳞状细胞癌（潘科斯特瘤）进行手术。在左侧使用T1 - 3 - 5椎弓根螺钉和右侧使用T1 - 5椎弓根螺钉进行后路内固定，随后进行右上叶切除术和半椎体切除术。在肿瘤一侧切除T2 - T4椎体的椎板和小关节。在肿瘤一侧硬脊膜囊外侧椎弓根内侧进行截骨。切除相邻四根肋骨的近端部分，以实现无瘤边缘的根治性整块切除。使用的四块肋骨板（MatrixRib预塑形板系统）的远端附着于肋骨近端。然后使用SILC™固定系统的柔性聚对苯二甲酸乙二酯（PeT）带将板的近端附着于后路固定结构的杆上。然后将PeT带的另一端穿过随后附着于后路固定杆的顶装夹。
患者无需额外的胸壁重建手术。在7个月的随访中，胸部CT显示剩余肺组织扩张良好，脊柱排列正常，胸廓解剖形态正常。
所报告的技术可应用于通过向胸廓延伸的切除术完成全椎体或次全椎体切除的病例中的胸壁重建。它似乎简单、安全且有效，可实现良好的美容和功能效果。
