颈椎骨巨细胞瘤手术治疗的中长期随访及预后分析

Giant cell tumor of the cervical spine:surgical treatment and outcomes with mid-term and long-term follow up

目的探讨颈椎骨巨细胞瘤（GCT）的临床特点、肿瘤切除方式及预后。方法手术治疗23例颈椎GCT，依据脊柱肿瘤WBB分期，采取椎体次全切除3例，矢状位切除5例，附件切除1例，全脊椎切除14例。脊柱重建方式采取单纯自体髂骨植骨和颈前路钛板、钛网植骨内固定或前后联合内固定加植骨融合。18例患者术后配合局部放疗。结果1例C1-2椎体、附件GCT患者在术后出现神经症状加重，术后10d因呼吸、循环系统衰竭死亡。22例获得3年～10年4个月的随访，患者术后颈部疼痛症状消失，神经根刺激症状得到不同程度的缓解，术后3个月患者神经功能Frankel分级，平均有1—2个级别的改善。植骨全部融合。内固定融合良好，未见脊椎失稳现象。椎体次全切除组复发3例；矢状位切除复发2例，而全脊椎切除组仅1例于术后4年复发。随访期内死亡4例，均为复发病例，1例行翻修手术后6个月出现肺部转移，13个月时死于肺部感染；另有3例均因肿瘤复发最终导致高位瘫痪、全身器官衰竭死亡。结论颈椎GCT是一种良性侵袭性或低度恶性肿瘤，手术治疗应在尽可能保留神经功能的前提下实施扩大范围的肿瘤切除术。全脊椎切除结合术后辅助放疗能明显降低局部复发率。

Objective To retrospectively study the clinical characteristics, resection mode and outcomes of Giant cell tumor of bone（GCT） in the cervical spine. Methods All clinical and follow-up data of 23 cases of GCT arising in the cervical spine which received surgical treatment were collected. The choice of surgical intervention was based on the WBB grading system. 3 patients underwent subtotal centrum resection, 5 patients underwent sagittal resection, 1 patient received appendix resection and 14 cases received total spondylectomy. For reconstructing the stability of cervical spine, autogeneic ilium for purely bone graft or titanium plate and titanium mesh for anterior internal fixation with bone graft or anterior and posterior combination internal fixation with bone graft were used. Postoperative radiation therapy was given in 18 cases as adjunctive therapy methods. Results 1 patient suffering C1-2 GCT with centrum and appendix invasion showed aggravation of neural dysfunction and died for respiratory and circulatory failure when 10 days after surgery. 22 cases got mid-term or long-term follow-up, ranging from 3years to 10years and 4 months. Symptom of pain in the neck disappeared in most cases, nerve root irritation relieved with different degree and patients suffering spinal cord compression symptom got well recovery with at least 1 or 2 level based on Frankel grading system in 3 months after operation. All of the bone graft got well fusion, and no spine instability could be seen in our series. Local recurrence was detected in all the three cases for subtotal centrum resection, two cases for sagittal resection but only one case for total spondylectomy in 4 years after surgery. 4 cases died within follow-up and all these patients are recurrent cases. Metastatic tumor to lung was found in 1 patient in 6 month after the surgical revision and the patient died because of pulmonary infection in 13 month. 3 with recurrent tumors caused high-level paralysis and multiple organ failure and died eventually. Conclusions As a nonmalignant but infiltrating or low potential malignant tumor, GCT in the cervical spine should be expanding excised as while reserve the neural function as a precondition. Total spondylectomy combined with postoperative radiation therapy could lower the rate of local recurrence prominently.