经高位颈前咽后联合后入路一期全椎体切除并环状重建技术治疗枢椎肿瘤效果分析  

Efficacy of one-stage total spondylectomy and circumferential reconstruction for axial tumors through a combined anterior retropharyngeal-posterior approach

作　　者：郭健峰 丁威中 方忠[1] 廖晖[1] 熊伟[1] 吴巍 李锋[1] Guo Jianfeng;Ding Weizhong;Fang Zhong;Liao Hui;Xiong Wei;Wu Wei;Li Feng(Department of Orthopedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《中华医学杂志》2022年第43期3423-3429,共7页National Medical Journal of China

基　　金：国家重点研发计划(2016YFB1101305)。

摘　　要：目的阐述经高位颈前咽后联合后入路一期全椎体切除并环状重建技术治疗枢椎肿瘤的安全性和有效性。方法回顾性分析2006年2月到2018年12月华中科技大学同济医学院附属同济医院共20例枢椎肿瘤患者的临床资料。所有患者均采用经高位颈前咽后联合后入路实施枢椎肿瘤全椎体切除,并采用异形钛网或3D打印(3DP)植入物重建。采用疼痛视觉模拟评分(VAS)和Frankel神经功能分级评估疼痛和神经功能情况,随访时予以影像学检查评估内固定及复发情况。结果20例患者中男12例,女8例,年龄(59.1±11.0)岁(31~72岁),手术时间(605.0±60.1)min(430~700 min),术中出血量(1250±347)ml(800~2400 ml),术后住院时间(13.2±2.8)d(8~20 d),随访时间(37.2±14.2)个月(14~66个月)。20例患者中,14例采用异形钛网前路重建,6例采用3DP植入物,5例采用枕颈固定,15例单纯颈椎固定;疼痛VAS评分由术前的(7.1±1.1)分降至末次随访时的(1.6±0.6)分(P<0.001);9例术前神经功能损伤患者随访时均改善,其中2例Frankel B级分别改善为C及D级,3例C级改善为D级,4例D级改善为E级。围手术期并发症包括:椎动脉损伤2例,吞咽困难2例,声嘶呛咳3例,脑脊液漏2例,枕大神经痛1例。末次随访时5例患者死亡,3例患者复发;仅1例患者因肿瘤复发导致内固定失败。结论经高位颈前咽后联合后入路一期全椎体切除并环状重建技术对枢椎肿瘤安全有效,临床效果满意,并发症少;异形钛网或3DP植入物前路重建联合后路钉棒固定可有效重建脊柱力学稳定性。Objective To elucidate the safety and efficacy of one-stage total spondylectomy and circumferential reconstruction through a combined anterior retropharyngeal-posterior approach for axial tumors.Methods A total of 20 patients with axial tumor who received total spondylectomy through a combined anterior retropharyngeal-posterior approach in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from February 2006 to December 2018 were retrospectively analyzed.Anterior reconstruction was performed with a special-shaped titanium mesh or three-dimensional printed(3DP)implants.The degree of local pain and neurological function was assessed by the visual analogue scale(VAS)and Frankel classification systems,respectively.Status of internal fixation and local recurrence was analyzed by radiological examination during follow-up.Results Among the 20 patients,12 were male and 8 were female with a mean age of(59.1±11.0)years(31 to 72 years).The mean operation time was(605.0±60.1)minutes(430 to 700 minutes)with a mean intraoperative blood loss of(1250±347)ml(800 to 2400 ml).The mean postoperative hospital stay was(13.2±2.8)days(8 to 20 days),and mean follow-up duration was(37.2±14.2)months(14 to 66 months).Anterior reconstructions were performed with a special-shaped titanium mesh in 14 patients and with 3DP implants in another 6 patients.Posterior occipital-cervical fixation was performed in 5 patients,while cervical fixation only in another 15 patients.The mean VAS score of pain at the last follow-up decreased significantly when compared with that before operation(1.6±0.6 vs 7.1±1.1,P<0.001).Nine patients with neurological deficits indicated significant improvement by at least 1 level at the last follow-up;among them,2 cases of Frankel B improved to Frankel C and D,respectively;3 cases of Frankel C all improved to Frankel D,and 4 cases of Frankel D improved to Frankel E.The perioperative complications included:2 cases of vertebral artery injury,2 cases of dysphagia,3 cases of hoars

关 键 词：寰枢关节 枢椎肿瘤 高位颈前咽后入路 全椎体切除 异形钛网 3D打印植入物 

分 类 号：R738.1[医药卫生—肿瘤]