颈椎肿瘤术中行徒手椎弓根螺钉内固定的疗效观察

Therapeutic efficacy observation of cervical spine tumor intraoperative pedicle screw osteosynthesis

目的:研究颈椎肿瘤行后路肿瘤切除、植骨融合、徒手置入椎弓根螺钉是否安全可行。方法:对吉林大学第一医院2008年1月～2011年4月内10例颈椎肿瘤患者(9例良性,1例为肝癌骨转移)行此手术治疗。结果:10例患者共置螺钉67颗,61颗置入准确,6颗穿破椎弓根皮质,准确率为91%。10例患者术中均有大量出血。4例术后出现神经症状,其中1例术后3周症状消失,另3例术后神经功能逐渐代偿,其余未发现神经血管症状。初置钉时有3颗螺钉松动,经处理后术后半年内复查均无拔钉现象。结论:颈椎肿瘤行后路切除、植骨融合、徒手置入椎弓根螺钉是可行的。熟练掌握颈椎解剖,做好充分术前准备,置钉个体化以及精细的手术操作对手术的成败起关键作用。

Objective： To study the feasibility and safety of posterior resection of cervical spine tumor,bone fusion and pedicle screw osteosynthesis by hand.Methods： 10 cases of patients with cervical spine tumors admitted to the first hospital of Jilin University in the past 3 years（9 cases of benign,1 case of liver cancer bone metastasis） were given the surgery.Results： A total of 67 screws were placed in 10 patients,among which 61 placements were accurate while the rest 6 penetrated the pedicle cortex,with accurate rate of 91%.10 patients had massive bleeding during surgery.4 cases demonstrated neurological symptoms after surgery,and the symptoms disappeared 3 weeks after surgery in 1 case,and the neurological function gradually compensated after surgery in the other 3 cases.There appeared no neurovascular symptoms in other cases.3 screws went loose when first placed,and no nail-pulling was observed in follow up within six months after treatment.Conclusion： The posterior resection of cervical spine cancer,bone fusion,hand pedicle screw placement are feasible.Well command of cervical anatomy,full preparation before surgery,individualized screw placement and delicate operation skills are the key to the success of the surgery.