前路病灶切除钛网植骨内固定治疗下颈椎椎体转移瘤

Treatment of lower cervical vertebral metastases by anterior approach excision and repair with titanium mesh bone grafting and plate internal fixation

目的 探讨前路病灶切除,并进行钛网植骨、钛板内固定治疗下颈椎椎体恶性肿瘤的临床应用价值.方法 采用前方入路行病灶清除、钛网植骨、钛板置入内固定及重建治疗18例下颈椎椎体转移瘤患者.采用Frankel、VAS进行评分,根据X线片评价椎体间高度及病椎段Cobb角的变化,记录术后并发症.结果 18例均得到随访,随访时间9～24个月（平均15.2个月）.末次随访Frankel、VAS进行评分较术前均得到明显的改善;椎体间高度及Cobb角有明显恢复.局部肿瘤无复发,无术后感染及内固定松动、脱出、断裂等.术后1例出现声嘶,4例因多处转移、多器官功能损害、全身衰竭死亡.结论 经前路切除病灶、钛网植骨、钛板置入内固定及重建是治疗下颈椎椎体转移瘤的有效方法.

Objective To investigate the clinical value of excision and repair with titanium mesh cage and bone graft combined with plate internal fixation by anterior approach in the treatment of lower cervical vertebral metastases （LCVM）. Methods Eighteen LCVM patients were treated by anterior excision, and were repaired with titanium mesh cage, bone graft and plate internal fixation. Complications, Frankel scores and VAS scores were recorded. X-ray films were performed to measure the distance between two bodies adjacent to the ill body and the Cobb angle. Results All patients were followed up successfully for an average of 15.2 months（ range ,9 - 24 months）. Frankel and VAS scores in final follow-up were significantly improved than preoperation, and the distance and the angle were significantly restored. No local tumor recurrence was observed, and no other complications occurred including postoperative infection, loosening, detachment and break of internal fixation. One patient had hoarse voice after the operation. Four were dead of systemic metastatic cancer. Conclusion Tumor excision and repair with titanium mesh cage and bone graft combined with plate internal fixation by anterior approach is an effective way to treat LCVM.