内窥镜辅助下前路上颈椎肿瘤切除与稳定性重建

Endoscopy-assisted anterior resection of upper cervical tumors and stability reconstruction

中文关键词:  脊柱肿瘤  寰椎  枢椎  内窥镜  脊柱融合术

英文关键词:Spinal neoplasms  Atlas  Axis  Endoscope  Spinal fusion

中文摘要:

  【摘要】 目的：探讨前路内窥镜辅助下经颈动脉三角C1~C2肿瘤切除、稳定性重建和后路内固定的手术特点以及临床治疗效果。方法：2006年1月~2009年12月收治8例上颈椎肿瘤患者，男性5例，女性3例，年龄16~51岁，平均35.6岁。枕颈部疼痛不适5例，合并神经症状3例（Frankel分级C级1例，D级2例）。均以枢椎椎体破坏为主，同时累及枢椎后柱者3例，累及寰椎前弓者1例。浆细胞瘤3例，转移癌2例，骨软骨瘤1例，嗜酸性肉芽肿1例，动脉瘤样骨囊肿1例。采用一期后路内固定植骨联合前路内窥镜辅助下肿瘤切除自体髂骨植骨重建，术后良性病变患者定期随访观察，原发恶性肿瘤及转移癌患者行辅助放疗或化疗。对所有患者临床资料进行回顾性分析。结果：围手术期无严重并发症发生。随访9个月~4年，平均24个月，CT证实植骨获得满意融合。3例术前伴有神经功能损害者末次随访时Frankel分级各改善1级。1例转移癌患者于术后11个月时死于肺癌，另1例转移癌患者术后9个月复发并出现多个椎体转移，1例浆细胞瘤患者术后17个月随访时转为多发性骨髓瘤，其余5例患者未见肿瘤复发或转移。结论：前路内窥镜辅助下切除上颈椎肿瘤、稳定性重建并后路内固定能够在一定程度上克服传统手术显露困难的缺点，减少手术并发症，但如何完成肿瘤一期彻底或整块切除还有待进一步研究。

英文摘要:

  【Abstract】 Objective：To evaluate the clinical efficacy of endoscopy-assisted anterior resection combined with posterior fixation for the treatment of upper cervical tumors.Method：From January 2006 to December 2009，8 cases（5 males，3 females） with upper cervical tumors received minimally invasive surgery in our department. The average age at admission were 35.6 years old（range，16-51 years）.The major lesion was at axis vertebral，additionally 3 cases got posterior elements and one patient had C1 anterior arch involved at the same time.The pathological diagnosis was plasma cell tumor in 3 cases，metastasis in 2 cases，osteochondroma in 1 case，eosinophilic granuloma in 1 cases and aneurysmal bone cyst in 1 case.Five patients presented with severe neck pain，other three patients had neurological deficit（according to the Frankel grade system，1 grade C，2 grade D）.All patients underwent single stage endoscopy-assisted resection of upper cervical tumors plus autograft and posterior fixation.Radiotherapy or chemotherapy was adopted postoperatively according to the pathological diagnosis.Retrospective analysis was completed in all cases.Result：No perioperative complications was observed.The average follow-up was 24 months（range，9 months to 4 years）.Solid bony fusion was confirmed by computer tomography.Three patients with neurological deficit prior surgery improved at least one level after operation.1 case with metastasis malignant died of lung cancer 11 months later after operation. Multi-level recurrence was noted in 1 patient 9 months later after operation.1 case with osteochondroma developed to multiple myeloma 17 months later.No tumor recurrence or metastasis were noted at final follow-up for the rest 5 cases.Conclusion：The technique of endoscopy-assisted anterior resection of upper cervical tumors and stability reconstruction can obviate the difficulties in exposing as well as reducing the rate of complication, however en bloc resection is technically challenging.