上颈椎哑铃型肿瘤切除后骨性结构复位重建  

Effect of reduction and reconstruction of the bony structure after one-stage posterior resection of high cervical tumors

作　　者：洪正华 陈伟富 王章富 洪盾[1] 郑光彬[1] 叶招明[2] 陈海啸[1] Hong Zhenghua;Chen Weifu;Wang Zhangfu;Hong Dun;Zheng Guangbin;Ye Zhaoming;Chen Haixiao(Department Orthopaedics, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai 317000, China;Deparment Orthopaedics, Second Affiliated Hospital of Zhejiang University, Hangzhou 130000, China)

机构地区：[1]浙江大学台州医院骨科,临海317000 [2]浙江大学医学院附属第二医院骨科,杭州310000

出　　处：《中华骨科杂志》2019年第14期855-862,共8页Chinese Journal of Orthopaedics

基　　金：浙江省公益技术研究计划(LGF18H060012).

摘　　要：目的探讨后路骨性结构切除后复位重建的方法治疗上颈椎哑铃型肿瘤的可行性以及临床疗效。方法回顾性分析2009年10月至2018年3月于台州医院收治并通过什么方法治疗的17例上颈椎哑铃型肿瘤患者资料,其中男10例,女7例,年龄26~84岁,平均57±23岁。17例的病理类型包括神经鞘瘤11例、脊膜瘤3例、同一节段同时出现神经鞘瘤和脑膜瘤3例,均为术后病理诊断。17例均一期后入路行肿瘤切除术,其中3例切除寰椎后弓或枢椎椎板棘突复合体原位复位且未行内固定,14例行切除或单开门的寰椎后弓或枢椎椎板棘突复合体原位复位后用微钢板进行内固定重建。临床疗效采用疼痛视觉模拟评分(visual analogue score,VAS)、日本骨科协会评估治疗(Japanese Orthopaedic Association scores,JOA)分数及美国脊髓损伤学会(American Spinal Injury Association,ASIA)分级等进行比较。影像学上测量比较术前及末次随访的颈椎生理曲度及活动度。结果本组17例均顺利完成手术,术中均未出现椎动脉损伤及大出血;手术时间113~265 min,平均(184±43) min,出血量100~900 ml,平均(203±223) ml。17例均获得随访,随访时间(29.1±28.2)个月,未发现局部复发;患者肌力及感觉较术前明显恢复,VAS评分及JOA评分均较术前明显改善,差异有统计学意义。术前ASIA分级为:C级1例,D级11例,E级5例。术后C级恢复至D级,8例D级恢复至E级,3例D级术后未恢复至E级。术后颈椎生理曲度及活动度较术前减少,但是嘱患者旋转及屈伸颈部时未诉明显的颈部僵硬以及不适。1例术中出现心跳骤停,停止操作后自行恢复心跳。9例术后出现脑脊液漏,术后无切口感染。结论上颈椎哑铃型肿瘤的手术治疗具有难度高、风险大、术后并发症发生率较高等特点,后路骨性结构切除后复位重建可有效恢复上颈椎稳定性,最大限度地保留颈椎的活动度,改善疗效。Objective To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors. Methods From October 2009 to March 2018,17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up. Results There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The

关 键 词：颈椎 修复外科手术 脊椎肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]