改良前方入路手术治疗颈胸段椎体病变

TREATMENT OF CERVICOTHORACIC JUNCTION SPINAL LESIONS BY MODIFIED ANTERIOR APPROACH

目的探讨改良前方入路治疗颈胸段椎体病变的手术方法。方法2000年9月~2005年1月,对23例C7~T3椎体病变患者均采用标准颈椎右前方入路联合胸骨柄正中劈开显露病变椎体,行病椎次全切除、植骨融合、内固定术。其中男15例,女8例;年龄24~62岁。颈胸段骨折3例,骨折合并脱位7例,结核6例,肿瘤7例;病变部位C6-T1、C6-T2节段各2例;C7-T1、T3节段各3例;T1节段8例;T2节段5例;病程3d^2年。术前Frankel分级A级2例,B级4例,C级7例,D级4例,E级6例。术后佩戴头颈胸支具3~6个月。结果术后23例均获随访10~42个月,全部患者椎间植骨3~6个月均获骨性愈合,无内固定失败,脊柱稳定性好。术后Frankel分级A级1例,B级0例,C级2例,D级10例,E级10例。Frankel分级平均提高1.3级。术后10个月1例肺癌全身转移死亡。余6例肿瘤患者随访时仍生存。结论采用改良前方入路暴露颈胸段病灶充分、安全,适用于颈胸段椎体病变的手术治疗。

Objective To investigate the therapeutic effect of the modified anterior approach in treatment of the patients with cervicothoracic junction spinal lesions. Methods From September 2000 to January 2005, 23 patients （15 males, 8 females） with spinal lesions in the cervicothoracic junction underwent a standard cervical approach, which was combined with a partial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Among the patients, 3 had fracture, 7 had dislocation, 6 had tuberculosis, and 7 had tumor. The pathologic change regions was as follows： 2 in the C6-T1 segment, 2 in the C6-T2 segment, 3 in the CT-T, segment, 3 in the Ta segment, 8 in the T, segment, and 5 in the Tz segment. The classification of Frankel were as follows; 2 at grade A, 4 at grade B, 7 at grade C, 4 at grade D, and 6 at grade E. All the patients underwent a radical excision of the affected spinal bone, were given a proper tricortical iliac crest and anterior instrumentation to reconstruct the anterior spinal column, followed by immobilization in a brace for 3-6 months. Results The mean follow-up period was 30 months （range, 10-42 months）. Bony fusion was obtained in all the patients. One patient died of pulmonary cancer metastasis 10 months after operation. The nerve function of the spinal cord recovered at different degrees （1 at grade A, None at grade B, 2 at grade C, 10 at grade D, 10 at grade E）. Conclusion Our modified anterior approach can provide a direct and safe access to the lesions in the region.