2018 年第 4 期 第 13 卷

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

作者：张群立薛文刘林舍炜李德霞

英文作者：

单位：730000兰州，甘肃中医药大学临床医学院（张群立）；730000兰州，甘肃省人民医院骨二科（薛文、刘林、舍炜、李德霞）

英文单位：

关键词：上颈椎肿瘤；椎体重建；螺钉固定

英文关键词：

• 摘要：

• 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C2、C3者3例，累及C2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 chordoma 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, C3 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］. 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.