颈胸段脊柱原发恶性肿瘤的手术治疗现状及进展

Progresses of surgical treatment for the cervicothoracic spinal primary malignant tumors

颈胸段脊柱（cervicothoracic junction,CTJ）向上连接颈椎,向下延续胸椎,是脊柱的一个特殊部位,多指C7~T4[1-3]。CTJ周围有复杂、重要的组织结构,如大动静脉（主动脉、腔静脉等）、重要器官（肺脏、气管、食管、胸导管等）、神经结构（神经根、喉返神经等）、骨性结构（胸骨、锁骨等）;在生物力学上,由前凸的颈椎过渡到后凸的胸椎,造成此处应力集中[4]。

Cervicothoracic spine is a special position in the anatomy and biomechanics. The anterior includes a variety of tissues, organs and nerves. And the lesion gets deeper owing to the chest. In addition, the concentrated spinal stress makes a high risk of failure of the internal fixation. So, surgical treatment is of great difficulty for primary malignant tumors at the cervicothoracic junction. There are many disputes in the surgical approach for the cervicothoracic tumors. The proximal C7-T1 lesions can obtain a clear exposure by an anterior low suprasternal approach alone. On the contrary, access to the distal T2-4 lesions through an anterior approach is generally considered to be difficult and need to be combined with sternotomy or thoracotomy. But the single posterior total spondylectomy can avoid large injury and severe complications caused by the anterior approach. Total spondylectomy can make spinal tumors reach the wide or marginal excision. In recent years, total spondylectomy is being widely used in the treatment of spinal primary malignant tumors, which is helpful to complete removal of the tumor and effective decrease of the local recurrence. Cervicothoracic junction changes from the lordosis and active cervical to kyphosis and relatively fixed thoracic vertebrae. It is also a significant change for vertebral morphology and spinal stress. For this reason, in the spinal reconstruction, the form and stress of the internal fixation have a certain specificity. This article reviewed the progress of surgical treatment and spinal reconstruction for cervicothoracic primary malignant tumors.