经颌下咽后入路钩状钛板内固定重建术治疗枢椎椎体肿瘤  

Submandibular retropharyngeal cervical vertebra hook-plate for the treatment of C2 vertebral body tumors

作　　者：晏怡果[1] 王文军[1] 蔡斌[1] 胡文凯[1] 王麓山[1] 宋西正[1] 赵延胜[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《中国骨科临床与基础研究杂志》2010年第3期191-195,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：湖南省卫生厅科技计划项目(B2009055)

摘　　要：目的评价经颌下咽后上颈椎前路钩状钛板(retropharyngeal cervical vertebra hook-plate,RCHP)内固定重建术治疗枢椎椎体肿瘤的临床效果。方法应用RCHP内固定结合植骨或骨水泥手术治疗枢椎肿瘤9例,其中恶性肿瘤7例,良性肿瘤2例。所有患者均有不同程度的枕颈部疼痛伴活动受限,均未发现明显的神经功能障碍。结果随访时间5～22个月,平均13个月。伤口均Ⅰ期愈合,术中无脊髓、重要神经及血管损伤。术后1例患者出现喝水呛咳、吞咽困难等喉上神经牵拉症状,予以神经康复治疗后1周内好转,2周内恢复正常进食。2例进行植骨的良性肿瘤患者术后3～6个月内获得植骨融合,平均4个月。所有病例均未见内固定松动。结论应用RCHP内固定治疗枢椎椎体肿瘤,可以Ⅰ期处理肿瘤病灶并进行稳定性重建,具有简便易行、安全性高、固定可靠、疗效优良等特点。Objective To evaluate the clinical results of submandibular retropharyngeal cervical vertebra hook-plate （RCHP） reconsruction for the treatment of C2 vertebral body tumors. Method Nine patients with C2 vertebral body tumors were treated with RCHP internal fixation and bone graft or cement reconstruction. Among these patients, seven were malignant tumors and two benign. All cases were found motion limitation of occipito-cervical region in different degrees without any obvious neurological disorders. Results Nine patients were followed up for 5-22 months （median 13 months）. All incisions primarily healed. No injuries occurred to the spinal cord, important nerves or blood vessels during surgery. One patient developed symptoms of superior laryngeal nerve stretching after the operation such as drink-bucking and acataposis. With neurological rehabilitation therapy, the patient improved in one week and complete recovered in two weeks. Two patients with benign tumors treated with internal fixation and bony graft had solid fusion at 3-6 months （average 4 months）. No screw or hook losening was found at the time of the last follow-up. Conclusion For C2 vertebral body tumors, RCHP system can be used successfully to treat focus and reconstruct C2 body on one-stage operation by submandibular retropharyngeal approach with the advantages of simple, convenient, safe and effective operation as well as reliable fixation.

关 键 词：脊椎肿瘤 枢椎 内固定器 钛 

分 类 号：R738[医药卫生—肿瘤] R687.3[医药卫生—临床医学]