异形钛笼在中上颈椎腹侧病变切除后稳定性重建中的应用

Application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection

中文关键词:  上颈椎  钛笼  椎体重建

英文关键词:Upper cervical spine  Titanium mesh  Vertebral body reconstruction

中文摘要:

  【摘要】 目的：探讨异形钛笼在中上颈椎腹侧病变切除后重建中的应用。方法：2004年6月~2010年6月收治10例中上颈椎腹侧病变需行病灶切除手术的患者，其中陈旧性结核2例，原发肿瘤5例，转移瘤3例；病变单纯涉及枢椎2例，C2+C3椎体7例，C2~C4椎体1例。术前JOA评分7~14分，平均10分。根据病变范围，在气管插管全麻下，4例患者采用常规单纯经口咽入路清除病灶，6例采用经口唇下颌骨劈开入路清除病灶。所有患者均应用异形钛笼重建椎体，5例行颈椎椎弓根或侧块钉棒固定（C1~C3固定2例，C1～C4固定3例），5例行枕颈钉棒固定（C0~C4固定1例，C0～C5和C0~C6固定各2例）；均行自体髂骨植骨融合。观察并发症发生、神经功能改善和植骨融合等情况。结果：10例患者均顺利完成手术，手术时间5～8h，出血量500～3000ml，术中椎体病灶清除顺利，脊髓受压解除彻底，未发生椎动脉、脊髓损伤和脑脊液漏。9例患者获随访，随访3～14个月，平均8个月，术后复查X线、CT结果均提示植骨获得骨性融合；无钛笼移位、松动及切口感染等并发症。术后临床症状得到明显改善，末次随访时JOA评分平均为14分。结论：异形钛笼可重建中上颈椎椎体前柱，联合颈椎后路固定可满意重建颈椎力学稳定性。

英文摘要:

  【Abstract】 Objectives: To explore the application of atypical titanium mesh in stability reconstruction after upper-middle cervical lesion resection. Methods: From June 2004 to June 2010, ten patients with ventral lesion involving the upper-middle cervical spine undergoing surgery were reviewed retrospectively. Of all patients, two had old tuberculosis, five had primary tumors, and three had metastasis. Two cases had C2 involved, seven had C2 and C3 involved, and one had C2-C4 involved. The average preoperative JOA score was 10(range 7-14). The preoperative X-ray, CT and MRI images of each patient were obtained. Under general anesthesia and according to the lesion sites, four cases underwent transoral approach, and the other six cases underwent transoral-transabiomandibular approach. Anterior lesions resection and reconstruction with atypical mesh was used in all patients, meanwhile one-stage posterior instrumentation was applied. Five cases had C1-2 instrumentation(C1-C3 in 2, C1-4 in 3), and five cases had occipital-cervical instrumentation (C0-C4 in 1, C0-C5 in 2 and C0-C6 in 2). Postoperative complications, bony fusion and JOA scores were observed at follow-up. Results: Ventral resections of the lesions and decompressions were completed successfully in all patients, with the operative time ranging from 5 to 8 hours and blood loss ranging from 500ml to 3000ml. No cerebrospinal fluid leakage, neural or vascular injury was noted. Nine cases were followed up for 3 to 14 months(average, 8 months). The clinical symptoms improved significantly with a mean JOA score of 14. A solid bone fusion confirmed by CT scan was observed at final follow-up. No postoperative complications such as internal failure and wound infection were found during the follow-up. Conclusions: Anterior atypical titanium mesh can be used to reconstruct the vertebral body, and a combined posterior instrumentation can ensure reliable upper-middle cervical stability.