一期经前后联合入路全脊椎切除术治疗颈椎肿瘤

One-stage total spondylectomy(TS) by anterior and posterior approaches for cervical vertebral tumors

目的探讨一期经前后联合入路全脊椎切除加重建术治疗颈椎肿瘤的可行性,以期为临床治疗颈椎肿瘤提供更可靠更有效的手术方式。方法 2003年2月~2012年1月间,37例颈椎肿瘤患者均行一期经前后联合入路全椎体切除加前路椎体重建和后路椎弓根钉棒系统内固定术。其中男22例,女15例;年龄22~74岁,平均48.1岁。颈椎肿瘤病灶位于C33例、C46例、C59例、C69例、C710例;颈椎原发性肿瘤27例,转移瘤10例﹙单发孤立转移病灶,且术前已切除原发病灶或同期切除病灶﹚。按Enneking分期：原发良性颈椎肿瘤S3 10例,8例伴病理骨折;原发恶性颈椎肿瘤ⅠA5例,Ⅱ12例;10例转移性颈椎肿瘤按Tokuhashi预后评分系统均小于8分,且预计生存时间大于半年以上。结果平均手术时间196min,术中平均失血量1100ml。术后随访12个月~9.2年,平均3.6年。所有病例术后疼痛消失或减轻,其中30例疼痛完全消失,7例疼痛明显缓解。术前和术后3个月患者的VAS评分分别为7.4±0.3和1.5±0.4,两者差异有统计学意义﹙=17.21,=0.000﹚。21例脊髓神经损伤的患者术后1年脊髓神经功能有明显的改善,神经功能JOA评分与术前比较有显著性差异﹙=18.39,=0.000﹚;原发颈椎肿瘤患者中,1例脊索瘤术后12个月肿瘤局部复发,行局部病灶清理手术,1例骨肉瘤和1例浆细胞瘤患者分别与术后14月和19月死于多器官转移;转移性颈椎肿瘤患者中1例前列腺癌、1例肾癌和1例肺癌的患者分别于术后7~12个月由于多器官转移死亡。其余的患者均存活至今,未发现局部复发和其他部位转移灶。结论一期经前后联合入路全脊椎整块切除术治疗颈椎肿瘤是安全可行的。在严格把握手术适应症条件下,能彻底＂根治＂颈椎肿瘤,并可有效控制术后肿瘤局部复发,从而治愈肿瘤或消除症状,最大限度地延长患者的生存时间和改善生存质量。

Objective To investigate the surgical results of one stage total spondylectomy﹙TS﹚by anterior and posterior approaches for cervical vertebral tumors and evaluate its benefit for these tumors.Methods A total of 37 patients with the cervical vertebral tumor treated with on stage TS by posterior and anterior approaches from Feb 2003 to Jan 2012 were reviewed,which included 22 males and 15 females with an average age of 48.1 years old.27 patients were suffered with the primary cervical vertebral tumors and 10 patients were diagnosed for the cervical vertebral metastasis tumors.There were 10 of S3,5 ofⅠA and 12 of Ⅱ according to Ennekinng stage system;The spinal reconstruction was obtained by titanium mesh filled with autograft for benign and low-grade malignant tumors and methylmethacrylate-filled titanium mesh for malignant tumors.The spinal stability was enhanced by posterior internal fixation with rod-screw system.Results The operation time is 196min and bleed loss is 1100ml on average.The follow-up period lasted from 12 months to 9.2 years.All cases had pain before operation,among which 30 cases obtained complete relief and 7 cases obtained partly relief after operation.In all cases with neurological deficit,they improved neurologically significantly than the pre-operation with the JOA score﹙ =18.39,=0.000﹚.Up to now,1 patient had be local recurrence after operation and 5 patients had dead on the following time.The others still are alive and no local recurrence.Conclusion One-stage total spondylectomy by anterior and posterior approaches for cervical vertebral tumor is feasible,safe and effective to cervical vertebral tumor resection and stability reconstruction,which has many advantages such as controlling local recurrence,spinal cord decompression thoroughly,relieving the pain,improving the life quality and prolonging the lifetime.