颈椎转移瘤外科治疗效果及不同术式选择策略

Surgical outcome and strategy for cervical metastasis

【摘要】目的探讨不同解剖节段颈椎转移瘤外科治疗术式选择策略及疗效。方法回顾性分析20018月至2009年接受手术治疗的31例颈椎转移瘤患者的临床资料，将颈椎按照解剖特点分为上颈椎（C1，C2）和下颈椎及颈胸段（C3-T1）。分别对患者的疼痛程度、神经功能、预期生存时间和一般状态进行评价。分析患者术后的症状改善、生存时间及术式选择的特点。结果31例患者中24例获得随访，患者颈痛症状和生活质量明显改善，术后中位生存时间为45个月。依解剖特点不同采用不同的术式：C1，C2转移瘤患者根据手术方式不同分为后路枕颈固定联合”I放射性粒子植入组（粒子植入组）和其他外科治疗组，粒子植入组术后中位生存时间（48．0-27．0）个月长于其他外科治疗组（22．0±8．3）个月。C3～T1转移瘤患者根据手术方式不同分为前路椎体切除组和前后路联合切除组，前后路联合切除组术后中位生存时间45．O个月长于前路椎体切除组18．0个月。结论外科治疗能有效地缓解颈椎转移瘤患者的疼痛症状、维持或改善神经功能、提高生活质量。上颈椎转移瘤外科治疗以稳定为主，常选择后路枕颈固定术，联合放射性粒子植入有助于局部病灶的控制。下颈椎及颈胸段转移瘤外科治疗以前路椎体次全切除、内固定为主，满足相应条件者可行前后联合人路全脊椎切除术。

Objective To investigate surgical strategy and outcome for cervical metastasis in differ- ent anatomical segments. Methods Data of 31 patients, who had undergone surgical treatment for cervical metastasis from 2001 to 2009, were retrospectively analyzed. Two anatomical regions were defined： upper cervical spine （CI and C2）and subaxial cervical spine plus eervicothoracic junction （C3-T1）. VAS score, Frankel grade, Tomita score and Karnofsky performance scale were used to evaluate pain, neurological sta- tus, expected survival time and general health. The improvement of symptoms, survival time and characteris- tics of surgical strategies for different anatomical regions were analyzed. Results Twenty-four patients were followed up successfully. An effective recovery in neck pain and quality of life was found after operation. The median survival time was 45.0 months. In upper cervical spine group, the surgical strategies included posterior occipitocervical fixation combined with l^I seed brachytherapy and other surgical methods, and the median survival time 48.0 months） of patients who underwent l^I seed brachytherapy was longer than that 22.0 of patients treated with other surgical methods. In C3-T~ metastasis group, patients who underwent com- bined anterior-posterior approach total spondylectomy had a longer survival time than those treated with an- terior corpectomy. Conclusion Surgical treatment can effectively relief neck pain, maintain or improve neurological function and improve quality of life. Doctors should choose different surgical strategies accord- ing to anatomical region of cervical metastasis. For upper cervical spine, the main purpose of surgery is to stabilize the cervical spine; the posterior occipitocervical fixation is usually chosen, and the ~25I seed brachytherapy is useful in local control of metastasis. For subaxial cervical spine and cervicothoracic junc- tion, the anterior corpectomy is usually chosen, and a combined anterior-posterior approach total spondylec- tomy can be used for patients with corresponding conditions.