一期前后路联合手术治疗上颈椎肿瘤的临床效果观察

Clinical observation of one-stage anterior and posterior approach surgery for upper cervical tumor

目的探讨一期前后路联合肿瘤切除、前路翼状钛笼椎体重建、后路椎弓根或侧块螺钉固定治疗上颈椎肿瘤的手术效果。方法回顾性分析2014年6月至2016年9月于甘肃省人民医院骨二科接受手术治疗的4例上颈椎肿瘤患者的临床资料,其中男1例、女3例;骨巨细胞瘤1例,脊索瘤1例,浆细胞瘤2例;美国脊髓损伤协会(ASIA)脊髓损伤分级D级3例,E级1例;累及C_2、C_3者3例,累及C_2者1例。患者均采用一期前后路联合肿瘤切除、前路翼状钛笼椎体重建、后路椎弓根或侧块螺钉固定术治疗。通过随访观察患者术后恢复情况。结果术后4例患者均获随访,随访时间4～18个月,平均(12±6)个月。4例植骨在术后6～8个月[平均(6.9±1.3)个月]内均完全融合;1例ASIA脊髓损伤分级从D级恢复至E级,其余3例无变化。术后1个月疼痛视觉模拟量表(VAS)评分(4.5±2.2)分,与术前[(7.1±1.5)分]比较明显降低(P=0.010);术后3个月VAS评分(4.2±2.3)分,与术前比较明显降低(P=0.008)。3例患者术后随访期内无病生存,1例浆细胞瘤患者术后13个月发现肱骨转移,随访期内带瘤生存。结论上颈椎肿瘤采用一期前后路联合肿瘤切除、前路翼状钛笼椎体重建、后路椎弓根或侧块螺钉固定治疗,术野暴露好,肿瘤切除彻底,术后疼痛缓解明显,短期随访疗效满意。

Objective To observe the effect of one-stage anterior and posterior approach resection, anterior cervical fusion using titanium mesh cage and posterior fixation on upper cervical spine tumor. Methods Clinical records of 4 patients（ 1 male and 3 females） with upper cervical spine tumor who had surgery from June 2014 to September 2016 in Gansu Provincial Hospital were retrospectively analyzed; there was 1 case of giant cell tumor, 1 case of ehordoma and 2 cases of plasmacytoma; 3 cases were American Spinal Cord Injury Association （ASIA） grade D and 1 case was grade E ; the tumor involved C2, Ca ＇in 3 cases and C2 in 1 case. All patients had one-stage anterior and posterior approach resection, anterior cervical fusion using titanium mesh cage and posterior fixation. Postoperative recovery was observed. Results Four patients were followed for 4-18 months; the mean follow-up time was （12 ±6） months. Bone graft fused in 6-8 months[ （6. 9± 1.3 ）months 1. One patient with ASIA grade D recovered to grade E after operation. Pain Visual Analogue Scale score 1,3 month after operation was significantly lower than that before operation[ （4. 5± 2. 2） , （4. 2 ± 2. 3 ） points vs （7.1 ± 1.5 ） points] （ P = 0. 010, 0. 008 ）. Three patients survived with no recurrence and metastasis during follow-up period; 1 patient with plasmacytoma had humeral metastasis in 13 months after operation. Conclusion One-stage anterior and posterior resection, anterior cervical fusion by titanium mesh cage and posterior fixation treating upper cervical spine tumor can provide a good surgical visual field and remove the tumor; the short-term efficacy is satisfactory.