一期后外侧入路手术治疗Ⅲ期颈椎哑铃形肿瘤的疗效  

Efficacy of one-stage posterolateral approach for resecting stages Ⅲ cervical dumbbell-shape tumors

作　　者：孔金海[1] 肖辉[2] 钟南哲 钱明[1] 孙正望 王君成[1] 杨兴海[1] 刘铁龙[1] 魏海峰[1] 严望军[1] 肖建如[1] 

机构地区：[1]第二军医大学附属长征医院骨肿瘤科,上海200003 [2]解放军第474医院骨科,新疆维吾尔自治区830013

出　　处：《脊柱外科杂志》2017年第1期24-29,共6页Journal of Spinal Surgery

摘　　要：目的探讨一期后外侧入路治疗Ⅲ期颈椎椎管内外哑铃形肿瘤的临床疗效。方法回顾性分析2006年1月—2013年12月第二军医大学附属长征医院骨肿瘤科收治的91例长征医院外科分期系统Ⅲ期的颈椎椎管内外哑铃形肿瘤患者的临床资料。所有患者均采用一期后外侧入路(后外侧肌间隙入路+侧块切除)钉棒/钉板系统内固定植骨融合术治疗,采用疼痛视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)及美国脊髓损伤协会(ASIA)分级观察患者临床症状改善和神经功能恢复情况。结果所有患者手术均顺利完成。手术时间(2.7±1.3)h,出血量(550±110)m L。所有患者术中无大血管、神经损伤,术后27例发生脑脊液漏,1例术后出现左上肢一过性肌力下降,1例右侧颈后部麻木加重,1例发生霍纳综合征,1例术中因左侧椎动脉撕裂而行椎动脉修补术。术后无伤口深部感染,仅1例术前曾放疗的患者术后伤口愈合不佳。术后VAS评分和NDI均较术前明显降低,差异有统计学意义(P<0.05)。91例患者的颈部疼痛症状消失,88例患者神经功能有不同程度恢复和改善,49例患者脊髓神经功能完全恢复。随访8~91(72.0±3.1)个月,末次随访时除2例死亡,其余均获得骨性融合。结论一期后外侧入路治疗Ⅲ期颈椎椎管内外哑铃形肿瘤疗效肯定,术后局部复发率和手术并发症发生率低,内固定重建对维持颈椎的稳定性具有重要价值。Objective To evaluate the effect of one-stage posterolateral approach for resecting stage Ⅲ cervical dumbbellshape tumors. Methods From January 2006 to December 2013,91 patients with stage Ⅲ cervical dumbbell-shape tumors received one-stage screw-rod/screw plate internal fixation with bone grafting and fusion via posteriorolateral approach. The clinical efficiency was judged by Visual Analogue Scale（VAS） score,neck disability index（NDI） and American spinal injury association（ASIA） grades. Results The operation time was（2.7±1.3）h,and the average blood loss was（550±110）m L. The complications included leakage of cerebrospinal fluid in 27 patients,Homer＇s syndrome in 1,and vertebra artery injury in 1. All the incisions healed except 1. Neurological function was restored to different extents in 88 patients,and spinal nerve function was completely restored in 49 patients. During the follow-up from 8 to 91 months（72.0±3.1 months）,bony fusion occurred in the final visit except 2 death. Conclusion One-stage posterolateral approach has definite therapeutic effects for resecting stage Ⅲ cervical dumbbell-shape tumors,with lower local recurrence rate and surgical complications. Reconstruction with internal fixation is of important value for maintaining the stability of the cervical spines.

关 键 词：颈椎 椎管 脊髓肿瘤 脊柱融合术 内固定器 

分 类 号：R739.42[医药卫生—肿瘤]