寰枢椎转移瘤的外科治疗

Surgical treatment of atlantoaxial metastases：a retrospective study

中文关键词:  转移瘤  寰枢椎  外科治疗

英文关键词:Metastasis  Atlantoaxial spine  Surgery

中文摘要:

  【摘要】 目的：探讨寰枢椎转移瘤外科治疗的疗效以及在肿瘤综合治疗中所起的作用。方法：对2001年6月至2009年8月在我院住院治疗的22例寰枢椎转移瘤患者的相关临床资料进行回顾性分析。依据不同的治疗方式将患者分为外科治疗组和保守治疗组，前者进一步分为后路枕颈固定联合125I放射性粒子置入组（后简称粒子置入组）和其他外科治疗组。分析三组患者的生存期及外科治疗组患者治疗后的症状缓解程度和生活质量评估。结果：22例患者中，17例（77.3%）获得随访资料，外科治疗组11例，其中7例行后路枕颈固定联合125I放射性粒子置入术，4例行单纯后路枕颈固定术或Halo-vest外固定；保守治疗组6例。治疗后中位生存时间：粒子置入组48.0±27.0个月，其他外科治疗组22.0±8.3个月，保守治疗组6.0±1.2个月，三组间比较差异有显著性（P＜0.05）；外科治疗组患者平均住院24.8d，颈痛症状和生活质量明显改善，VAS颈痛评分自治疗前8.4分下降至治疗后3.0分，Karnofsky日常状态评分由治疗前65.5分上升至治疗后79.1分，与保守治疗组比较差异有显著性（P＜0.05）。结论：对病灶累及寰枢椎稳定的转移瘤，后路枕颈固定能够迅速重建上颈椎稳定，改善患者生活质量；枕颈固定联合125I放射性粒子置入放疗能够在提供稳定性的同时持续破坏肿瘤细胞，可能有助于转移灶局部病变的控制。

英文摘要:

  【Abstract】 Objective：To evaluate the results and contribution of surgical treatment for atlantoaxial metastases.Method：A total of 22 inpatients diagnosed with atlantoaxial metastatic tumors from June，2001 to August，2008 were reviewed retrospectively.All patients were classified into the surgery group and the conservative treatment group and the former was subgrouped into 125I Seed brachytherapy combined with craniocervical instrumentation group and other surgical group based on surgical protocols.The mean survival，surgical outcome and life quality between each group were compared.Result：Of 22 cases，17 patients（77.3%） had been followed up.7 patients in 125I seed brachytherapy group，4 patients in other surgery group （craniocervical instrumentation/Halo-vest immobilization） and 6 patients in conservative treatment group.The mean survival time for three groups was 48.0±27.0 months，22.0±8.3 months and 6.0±1.2 months respectively，which showed statistical significance（P＜0.05）.Patients in surgery group had neck pain relieved and life quality improved significantly after an average of 24.8 days in hospital periods.Visual analog scale for neck pain reduced from 8.4 points to　3.0 points；Karnofsky performance score increased from　65.5 points to 79.1 points，both had statistical significance（P＜0.05）.Conclusion：For atlantoaxial metastases complicated with stability impairment，posterior craniocervical instrumentation can reconstruct stability and improve the life quality，while this protocol combined with 125I seed brachytherapy can simultaneously kill tumor cells continuously which is aimed to control local recurrence.