异形钛笼在中上颈椎腹侧病变切除后稳定性重建中的应用  

Application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection

作　　者：马向阳[1] 尹庆水[1] 夏虹[1] 吴增晖[1] 杨进城[1] 许俊杰[1] 章凯[1] 王建华[1] 艾福志[1] 王智运[1] 麦小红[1] 

机构地区：[1]广州军区广州总医院骨科医院脊柱外科,广州市510010

出　　处：《中国脊柱脊髓杂志》2012年第10期894-897,共4页Chinese Journal of Spine and Spinal Cord

基　　金：军队临床高新技术重点项目(编号:2010gxjs032)

摘　　要：目的：探讨异形钛笼在中上颈椎腹侧病变切除后重建中的应用。方法：2004年6月-2010年6月收治lO例中上颈椎腹侧病变需行病灶切除手术的患者，其中陈旧性结核2例，原发肿瘤5例，转移瘤3例；病变单纯涉及枢椎2例，C2＋C3椎体7例，C2～C4椎体1例。术前JOA评分7～14分，平均10分。根据病变范围，在气管插管全麻下。4例患者采用常规单纯经口咽入路清除病灶，6例采用经口唇下颌骨劈开入路清除病灶。所有患者均应用异形钛笼重建椎体，5例行颈椎椎弓根或侧块钉棒固定（C1-C3固定2例，C1～C4固定3例），5例行枕颈钉棒固定（C0～C4固定1例．C0～C5和CO—C6固定各2例）；均行自体髂骨植骨融合。观察并发症发生、神经功能改善和植骨融合等情况。结果：10例患者均顺利完成手术，手术时间5—8h，出血量500～3000ml，术中椎体病灶清除顺利，脊髓受压解除彻底，未发生椎动脉、脊髓损伤和脑脊液漏。9例患者获随访，随访3—14个月，平均8个月，术后复查X线、CT结果均提示植骨获得骨性融合；无钛笼移位、松动及切口感染等并发症。术后临床症状得到明显改善．末次随访时JOA评分平均为14分。结论：异形钛笼可重建中上颈椎椎体前柱，联合颈椎后路固定可满意重建颈椎力学稳定性。Objectives： To explore the application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection. Methods： From June 2004 to June 2010, ten patients with ventral le- sion involving the upper-middle cervical spine undergoing surgery were reviewed retrospectively. Of all pa- tients, two had old tuberculosis, five had primary tumors, and three had metastasis. Two cases had C2 in- volved, seven had C2 and C3 involved, and one had C2-C4 involved. The average preoperative JOA score was 10（range 7-14）. The preoperative X-ray, CT and MRI images of each patient were obtained. Under gen- eral anesthesia and according to the lesion sites, four cases underwent transoral approach, and the other six cases underwent transoral-transabiomandibular approach. Anterior lesions resection and reconstruction with atypical mesh was used in all patients, meanwhile one-stage posterior instrumentation was applied. Five cases had C1-2 instrumentation（C1-C3 in 2, C1-4 in 3）, and five cases had occipital-cervical instrumentation （C0- C4 in 1, C0-C5 in 2 and C0-C6 in 2）. Postoperative complications, bony fusion and JOA scores were ob- served at follow-up. Results： Ventral resections of the lesions and decompressions were completed successfully in all patients, with the operative time ranging from 5 to 8 hours and blood loss ranging from 500ml to 3000ml. No cerebrospinal fluid leakage, neural or vascular injury was noted. Nine cases were followed up for 3 to 14 months（average, 8 months）. The clinical symptoms improved significantly with a mean JOA score of 14. A solid bone fusion confirmed by CT scan was observed at final follow-up. No postoperative complica- tions such as internal failure and wound infection were found during the follow-up. Conclusions： Anterioratypical titanium mesh can be used to reconstruct the vertebral body, and a combined posterior instrumenta- tion can ensure reliable upper-middle cervical stability.

关 键 词：上颈椎 钛笼 椎体重建 

分 类 号：R687.3[医药卫生—骨科学]