上颈椎哑铃形肿瘤的外科治疗及中远期随访结果

Surgical treatment and long-term follow-up results of dumbbell-shaped tumors of upper cervical spine

目的:探讨上颈椎哑铃形肿瘤的外科治疗策略及中远期随访结果。方法:回顾性纳入2003年1月至2015年12月收治的上颈椎哑铃形肿瘤患者24例,其中男15例,女9例;年龄35~67岁,平均(48.7±13.9)岁。C1-2占位12例,C2占位3例,C2-3占位7例,C1-3占位2例;北京大学第三医院(PUTH)分型:2型3例,3型10例,4型2例,5型6例,6型1例,7型2例;Frankel分级:C级3例,D级15例,E级6例。所有患者根据PUTH分型选择手术方法,记录术中出血量、手术时间、并发症发生情况,并采用视觉模拟评分(VAS)、Frankel分级、日本骨科协会(JOA)评分、卡氏人体机能状态量表(KPS)评分对临床疗效进行评估,并根据X线情况评估颈椎生理曲度及上颈椎稳定性情况。结果:本组患者平均手术时间为(236.6±49.8)min,术中平均出血量为(1260.4±283.0)mL,所有患者均获得随访,随访时间为64~121个月,平均(87.8±9.6)个月。术后12个月及末次随访的VAS评分、JOA评分和KPS评分较术前均有明显改善(P均<0.05)。末次随访时,Frankel分级提高了0~2级。末次随访颈椎生理曲度22.44°±9.69°,较术前26.35°±12.16°降低,但两者比较差异无统计学意义(t=1.23,P=0.23);随访过程中均未出现椎动脉损伤、心搏骤停、内固定松动及断裂、相邻颈椎节段不稳定等情况。结论:根据PUTH分型选择手术方法治疗上颈椎哑铃形肿瘤中长期随访结果取得了良好的临床及影像学疗效,能彻底切除肿瘤,重建上颈椎稳定性。

Objective:To explore the surgical treatment strategy and long-term follow-up effect of dumbbell-shaped tumor of the upper cervical spine.Methods:A total of 24 patients with dumbbell-shaped tumors of upper cervical spine treated in our hospital from January 2003 to December 2015 were retrospectively analyzed.There were 15 males and 9 females with a mean age of(48.7±13.9)years(range,35-67 years).C1-2 was invloved in 12 patients,C2 invloved in 3,C2-3 invloved in 7,and C1-3 invloved in 2.According to PUTH classification,there were 3 cases of type 2,10 cases of type 3,2 cases of type 4,6 cases of type 5,1 cases of type 6,and 2 cases of type 7.Frankel grade:3 cases of grade C,15 cases of grade D,and 6 cases of grade E.All patients were treated according to PUTH classification.The amount of intraoperative bleeding,operation time and complications were recorded.Clinical efficacy was evaluated with VAS score,Frankel grade,JOA score and KPS score,and the cervical physiological curvature and upper cervical stability were evaluated according to the X-ray examination.Results:The mean operation time was(236.6±49.8)min,and the mean intraoperative bleeding was(1260.4±283.0)mL.All patients were followed up for 64 to 121 months,with a mean time of(87.8±9.6)months.The VAS,JOA and KPS scores at 12 months after operation and at the last follow-up were significantly improved compared with preoperative ones(P<0.05).At the last follow-up,the improvement of Frankel grade ranged from 0 to 2.The cervical physiological curvature(22.44°±9.69°)was lower than preoperative one(26.35°±12.16°)at the final follow-up,but there was no significant difference between pre and post-operative physiological curvature(t=1.23,P=0.23).No vertebral artery injury,cardiac arrest,internal fixation looseness or breakage,instability of adjacent cervical segments occurred during follow-up.Conclusions:According to the PUTH classification,the treatment strategies of the upper cervical dumbbell-shaped tumor can achieve good curative effect,which can completely remove the tumor and restore the stability of the upper cervical spine.