上颈椎椎管内肿瘤外科考量及临床疗效（英文）

Clinical therapeutic effect of surgery on upper cervical spinal cord tumors

目的:评估钉棒系统用于颈椎后路关节融合术治疗上颈椎脊髓肿瘤患者的手术考量及长期疗效。方法:回顾2007年3月至2013年5月因上颈髓肿瘤在中南大学湘雅二医院行肿瘤切除及颈椎后路关节融合术的22例患者的医疗记录,其中包括男性10例,女性12例,年龄16~60岁。所有患者接受肿瘤切除,通过多轴钉棒系统对上颈椎(颈1~3)进行后路关节融合术。所有患者接受平均5年的临床及影像学随访。结果:平均随访时间为65.5个月。22例患者共置入114枚螺钉,组织病理学结果提示:神经鞘瘤16例,脊膜瘤3例,神经节细胞瘤1例,神经节神经胶质瘤1例,混合肿瘤(成分包括神经节细胞瘤和神经鞘瘤)1例。所有病例均获成功融合,术后日本骨科协会(Japanese Orthopaedic Association,JOA)评分为13.9分,治愈率为51.4%。1例术后发生颈椎后凸和肿瘤复发,神经功能障碍加重2例。未发现脊髓损伤、椎动脉损伤、术后神经根病、螺钉拔出或内固定失败等并发症。结论:通过多轴钉棒系统行颈椎后路关节融合术用于治疗上颈椎脊髓肿瘤,能够获得满意的长期临床和影像学疗效,无严重并发症发生。

Objective:To evaluate the long-term clinical therapeutic effect of polyaxial screw-rod system for posterior cervical arthrodesis on patients with upper cervical spinal cord tumors.Methods:From March 2007 to May 2013,22 patients with upper cervical spinal cord tumors underwent tumor resection and posterior cervical arthrodesis in our institution.The medical records of these patients were reviewed respectively.There were 10 males and 12 females with ages ranging from 16 to 60 years old.Posterior cervical arthrodesis by polyaxial screw-rod was performed at the upper cervical spine(C1-3).All patients were followed-up clinically and radiographically.Results:The average follow-up was 65.5 months.Twenty-two patients were enrolled and a total of 114 screws were placed in this study.Histopathology revealed neurinoma,meningioma,ganglioneuroma and ganglioglioma in 16,3,1 and 1 case（s）,respectively.The mixed tumor with component of ganglioneuroma and neurinoma was observed in 1 case.All patients received tumor resection and posterior athrodesis by polyaxial screw-rod system.Cervical kyphosis was encountered in one patient and this patient suffered the recurrence of tumor.Solid fusion was achieved in all patients.The average postoperative Japanese Orthopaedic Association（JOA） score was13.9 and the average recovery rate was 51.4%.Neurologic deterioration was found in 2 patients.No complications,such as spinal cord or vertebral artery injury,postoperative radiculopathy or instrumentation failure,were observed.Conclusion:The long-term clinical therapeutic effects of posterior cervical arthrodesis using polyaxial screw-rod system on upper cervical spinal cord tumors are satisfactory,with no severe complication.