复杂原发性颈椎及颈椎管内肿瘤的外科治疗

Surgical treatment for complex primary cervical tumors

目的探讨复杂颈椎肿瘤治疗的外科手术策略。方法本组共治疗了14例复杂颈椎肿瘤,分别为:椎管内外哑铃型神经鞘瘤8例、神经纤维瘤1例、骨巨细胞瘤2例、动脉瘤样骨囊肿2例、脊索瘤1例。年龄19～71岁(平均43.3岁),男7例,女7例。术前采用MR、CT、MR血管造影等技术对肿瘤性质、范围,肿瘤与椎动脉等周围重要解剖结构的关系进行评估,以易于显露肿瘤及尽可能不骚扰脊髓为原则,选择前路、后路或前后路联合手术入路,以尽可能将肿瘤完全切除并行力学重建。术前术后分别对脊髓功能进行JOA评分,评价手术减压效果。结果14例患者肿瘤被肉眼下完全切除,所有病例随访6个月～2年,14例均获得随访。术前评分平均12.2±0.5分,术后平均评分15.4±0.6分。除1例脊索瘤患者患者及1例神经纤维瘤患者复发再次手术外,其余病例未见复发,疗效满意。结论对于侵犯颈椎椎管内外的哑铃型肿瘤、解剖部位较高范围较大的原发性椎体肿瘤,通过术前影像学检查,确定相应的手术入路,可以安全彻底的将肿瘤切除,收到比较理想的效果。

Objective To investigate the surgical treatment for complex primary cervical tumors. Methods Fourteen cases of complex primary tumors in the cervical spine were treated. They were 7 men and 7 women, aged from 19 to 71 （average 43.3）. The tumors were giant cell tumor （n=2）, dumbbell-type schwannoma （n=8）, aneurysmal bone cyst （n=2）, fibroneuroma （n=1） and chordoblastoma （n=1）. All patients were studied retrospectively in this research. Before operation, CT, MR and MRA techniques were used to assess the nature and range of the tumors, and the anatomical relation with the surround tissues. The tumors were resected with anterior or/and posterior apporaoches. The biomechanical functions of the cervical were restored. Pre- and post-operatively, the JOA factors were calculated respectively. All the patients were followed up for 6 to 24 months （average 13 months）. Results The JOA scores increased from 12.2 ± 0.5 to 15.4 ± 0.6 post-operatively. All patients showed good states, except 1 case of fibroneuroma and 1 case of chordoblastma who had recurrence and underwent revision operation or radiotherapy. Conclusions The complex primary cervical tumors and cervical dumbbell-type tumors could be resected completely by surgery with combined anterior or/and posterior approach, and the biomechanical function could be reconstructed with proper method successfully.