胸腰椎肿瘤全脊椎切除术后的稳定性重建及其并发症

目的 探讨胸腰椎肿瘤全脊椎切除术后与稳定性重建相关的并发症.方法 1997年1月至2009年12月接受全脊椎切除术且随访及存活时间超过18个月的胸腰椎肿瘤患者34例,男20例,女14例;年龄15～72岁,平均43岁.胸椎27例,腰椎7例.脊柱转移瘤6例,原发骨肿瘤28例.全脊椎分块切除23例,整块切除11例.后路椎弓根钉棒系统短节段固定19例,长节段固定13例,短节段前路固定2例.前方椎体重建采用钛网植骨20例,钛网骨水泥7例,骨水泥填塞2例,单纯植骨2例,带加强环的钛网植骨1例,人工椎体植骨2例;后方碎块植骨26例,大块桥接植骨8例.结果 随访18～128个月,平均43个月.7例死亡.4例原发肿瘤行分块切除者复发,1例行整块切除者复发.25例椎体间植骨者融合不良5例.术后患椎上、下椎体间矢状面Cobb角平均-6°(-34.2°～15.5°),末次随访或翻修术前9.3°(-17.5°～57.2°),丢失16.0°(1.2°~65.4°),后方多节段固定者丢失14.1°(0.8°～36.5°),短节段固定者丢失21.5°(4-4°～65.4°).内固定断裂5例、内固定松动2例,钛网下沉6例、移位3例.人工椎体置换病例无明显下沉和移位.2例行前后路翻修,2例更换断棒,1例更换螺钉.结论 全脊椎切除术后与脊柱稳定性重建相关的并发症较多.后方长节段经椎弓根固定配合大块桥接植骨、前方应用人工椎体置换与植骨可使脊柱获得坚强的临时固定与长期融合.

Abstract：

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

53例肝癌切除术后生存20年以上远期随访分析

Objective To clarify the clinicopathological features of patients surviving≥20 years after resection for hepatoceUular carcinoma(HCC).Methods Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC.Of the 396 patients, 53(13.4 %) survived ≥20 years and 343(86.6%) <20 years.A comparative study between the two groups was made.Results By March of 2007, 67.6%(36/53) of the patients were still alive and disease-free while 5.7% (3/53) of them died of tumor recurrence or metastasis, 11.3 % (6/537 died of liver failure, 5.70% (3/537 died of other disease, and 9.4% (5/53) were lost during follow-up.Two patients with intraperitoneal rup-tured HCC survived fro 26.6 years and 38.75 years, respectively.Five young patients got married af-ter resection and have had babies.The longest surviving time was 43 years and 2 months.Reresection for recurrence was done in 9 patients and the mean survival was 26 years and 11 months.Reresection for solitary pulmonary metastasis was performed in 3 patients and the mean survival was 29 years and 2 months.Downstaging followed by resection was performed in 4 patients, mean survival being 22 years and 10 months.In comparison with patients surviving <20 years, those surviving ≥20 years were significantly younger(P<0.05) and had a higher incidence of asymptomatic tumors (P<0.01), lower γ-glutanyl transpeptidase levels (P<0.01), lower incidence of liver cirrhosis (P<0.01) ; high-er percentage of smaller tumors (P<0.01), single nodule tumors (P<0.01) and well encapsulated tumors (P<0.01), lower incidence of tumor emboli in portal vein (P<0.01), better differentiation of tumor cells (P<0.05) and higher curative resection rate (P<0.01).Conclusions Early and cura-tive resection are important for improving long-term survival.Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life.Reresection for re-currence and metastasis is an important approach to improve prognosis.     

寰枢椎肿瘤切除和重建技术的初步报告

目的 总结寰枢椎肿瘤手术显露和彻底切除的方法,评价异形钛网植骨融合内固定在寰枢椎肿瘤切除术后枕颈稳定性重建中的作用和价值.方法 2005年3月至2007年8月手术治疗6例寰枢椎肿瘤患者,男3例,女3例;年龄17～70岁,平均43.7岁;脊索瘤4例,骨巨细胞瘤1例,骨纤维异常增殖症1例.病变累及所有患者的椎体及侧块或后方结构.全部采用前方颌下颈动脉三角入路联合后方枕颈入路,按照"无瘤操作"的原则行病椎全脊椎切除,前路行异形钛网植骨融合内固定,后路行枕颈固定术,同时行Halo-vest架外固定,术后随访6～16个月.结果 C1.2切除1例,C2.3切除2例,C2切除3例.平均手术时间7.2h,平均术中出血量2400 ml.所有患者局部疼痛和神经症状减轻或消失,未出现神经、血管损伤,1例脊索瘤患者术后1年出现局部复发.至末次随访时所有患者头部位置良好,均达到枕颈区稳定,未出现内固定松动、断裂和移位.结论 按"无瘤操作"的原则行包膜外肿瘤切除可以获得较好的疗效;异形钛网植骨融合内固定术结合枕颈固定术,同时辅以Halo-vest架外固定,可以提高手术的安全性,并能在寰枢椎肿瘤切除术后有效地重建上颈椎的稳定性,实现即刻稳定,便于患者早期下床活动,提高患者生活质量,且手术操作简便易行,适合在寰枢椎肿瘤切除术中应用.     

颈椎骨巨细胞瘤手术治疗的中长期随访及预后分析

目的探讨颈椎骨巨细胞瘤（GCT）的临床特点、肿瘤切除方式及预后。方法手术治疗23例颈椎GCT，依据脊柱肿瘤WBB分期，采取椎体次全切除3例，矢状位切除5例，附件切除1例，全脊椎切除14例。脊柱重建方式采取单纯自体髂骨植骨和颈前路钛板、钛网植骨内固定或前后联合内固定加植骨融合。18例患者术后配合局部放疗。结果1例C1-2椎体、附件GCT患者在术后出现神经症状加重，术后10d因呼吸、循环系统衰竭死亡。22例获得3年～10年4个月的随访，患者术后颈部疼痛症状消失，神经根刺激症状得到不同程度的缓解，术后3个月患者神经功能Frankel分级，平均有1—2个级别的改善。植骨全部融合。内固定融合良好，未见脊椎失稳现象。椎体次全切除组复发3例；矢状位切除复发2例，而全脊椎切除组仅1例于术后4年复发。随访期内死亡4例，均为复发病例，1例行翻修手术后6个月出现肺部转移，13个月时死于肺部感染；另有3例均因肿瘤复发最终导致高位瘫痪、全身器官衰竭死亡。结论颈椎GCT是一种良性侵袭性或低度恶性肿瘤，手术治疗应在尽可能保留神经功能的前提下实施扩大范围的肿瘤切除术。全脊椎切除结合术后辅助放疗能明显降低局部复发率。     

前、后联合入路全脊椎切除附加内固定治疗颈椎骨肿瘤39例报告

目的探讨对颈椎骨肿瘤采用前后联合入路全脊椎切除、内固定重建技术的疗效及其预后。方法1998年10月至2003年10月,对39例颈椎(C3-7)骨肿瘤患者实施全脊柱切除术。其中原发性骨肿瘤34例,包括骨巨细胞瘤14例,浆细胞瘤6例,神经鞘瘤(侵及椎体)1例,软骨肉瘤4例,骨母细胞瘤4例,恶性神经鞘瘤2例,动脉瘤样骨囊肿2例,脊索瘤1例;转移性肿瘤5例,原发灶来源于甲状腺癌、前列腺癌各2例,肺癌1例。经前后联合入路行单椎节切除29例、双椎节切除7例、3个椎节切除3例。经一期或二期前后联合入路行肿瘤切除与内固定重建。前路采用钛网植骨加AO、Orion、Zephir或者Codman等带锁钢板内固定,后路Cervifix、AXIS内固定重建。结果术后随访6个月至5年,绝大多数患者术后近期疗效较满意,局部疼痛和神经症状均有不同程度改善或缓解,19例脊髓神经功能完全恢复。1例术后出现一过性瘫痪加重,1例恶性神经鞘瘤术后1年局部复发,1例转移癌患者于术后25个月因全身衰竭死亡。结论全脊椎切除能显著降低颈椎原发性骨肿瘤局部复发率,改善脊髓神经功能,提高手术疗效。     

椎间盘及部分椎体切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴椎体后缘骨赘

目的 评价颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘的疗效. 方法 应用颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘22例.取颈椎前路手术切口,术中仅切除突出的椎间盘及相邻椎体的1/3～ 1/2,使脊髓得到彻底的减压.再用填满碎骨的钛网植于骨缺损处加用钛板螺丝钉内固定,固定范围仅限于相邻椎体.术前和术后通过神经功能JOA评分、颈部轴性症状、颈椎动态侧位片和颈椎MRI比较临床疗效. 结果 均获随访,平均15(6 ～24)个月,术后JOA评分优良率86.4％,颈部轴性症状减轻,脊髓功能明显得到恢复.颈椎活动度良好.X线检查见钛网植骨及钛板内固定良好,未见不稳现象.MRI示颈髓压迫解除. 结论 颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴相邻椎体骨赘效果显著,可最大限度地保留颈椎节段的活动度.     

颈椎孤立性浆细胞瘤的外科干预及放疗结果分析

目的 探讨颈椎孤立性浆细胞瘤的临床特点、治疗方法及结果.方法 回顾性分析我科1995年1月至2007年12月收治的23例颈椎孤立性浆细胞瘤患者的临床资料,其中男性16例,女性7例,年龄32～76岁,平均56岁.23例患者除2例仅行单纯放疗外,余21例均行手术治疗.依据脊柱肿瘤WBB分期,采取全椎体切除6例,附件切除4例,矢状切除3例,全椎节切除8例,手术病例采用前路、后路或前后联合入路.脊柱重建方式采取自体髂骨植骨和颈前路钛板、钛网骨水泥内固定或前后联合植骨融合内固定,术后均行辅助放疗.结果 23例患者获得随访,随访时间24.0～143.0个月,平均64.7个月.患者术后颈部疼痛症状明显好转,神经压迫症状消失或得到不同程度的改善,术后3个月患者神经功能Frankel分级平均有1～2个级别的改善.内固定位置及颈椎稳定性良好,无脊柱失稳现象,植骨融合率100%.随访期内有6例局部复发,且进展为多发性骨髓瘤(MM),死亡3例.2例未手术者分别于确诊后1年及1.5年进展为MM,转血液科进一步化疗.15例患者术后辅助放疗后一般情况良好,随访期内复查M蛋白、骨髓穿刺等检查均未见明显异常,单光子发射计算机断层扫描或PET-CT检查未发现其他部位骨骼有新发病灶.结论 颈椎孤立性浆细胞瘤临床较为少见,对于骨质破坏明显、椎节不稳或神经功能障碍者,首选手术治疗;术后辅助放疗能明显降低局部复发率及进展为MM的可能性,进展为MM者应根据相应化疗方案进行化疗,预后相对较差.     

一期经口前路肿瘤切除和前后路椎体重建治疗枢椎骨巨细胞瘤

目的：探讨枢椎肿瘤切除和椎体重建的新方法.方法：采用经口咽入路枢椎体肿瘤切除,改良异形钛笼重建椎体,同期后路寰椎椎弓根和第三颈椎侧块钉棒固定植骨融合治疗枢椎体骨巨细胞瘤,并辅以放疗.结果：术后患者临床症状立即消失,行走正常,影像学示肿瘤切除干净,脊椎重建固定稳妥.结论：一期经口前路联合后路行枢椎肿瘤切除椎体重建是治疗枢椎肿瘤的可行方法,但远期疗效有待观察.     

颈椎肿瘤单侧关节突关节切除后的稳定性重建

目的：探讨颈椎肿瘤单侧关节突关节切除后稳定性重建的方法及效果。方法：对1999—2005年存我院骨科手术治疗且得到随访的18例切除单侧关节突关节的颈椎肿瘤患者的资料进行分析，男10例，女8例；年龄16～72岁，平均46岁。神经根受压表现为主者10例，VAS评分2～8分，平均4．2分；脊髓压迫表现为主者8例．ASIA分级C级5例．D级3例。均采用颈后路患侧关节突关节、侧块切除，完整切除肿瘤组织，其中10例行单侧侧块钢板固定植骨融合，8例行双侧侧块钢板固定植骨融合。结果：随访3—60个月，平均20个月，1例透明细胞癌肺转移患者死亡．余存活无复发。10例神经根受压表现为主者术后疼痛VAS评分0—4分，平均1．6分。8例脊髓压迫表现为主者，5例术前C级者术后C级2例、E级3例，3例术前D级者术后D级2例．E级l例。双侧侧块钢板固定植骨融合者术后3个月4例m现骨性融合（其中1例3个月后失访），6个月7例达到骨性融合，内固定无断裂、松动、移位。无颈椎不稳。单侧侧块钢板固定植骨融合者．1例术后5个月出现颈部疼痛；9例在术后9个月骨性融合；1例12个月时仍未能骨性融合，螺钉松动。结论：颈后路侧块钢板同定植骨融合可以实现颈椎肿瘤单侧关节突关节切除后的颈椎稳定性重建。     

颈椎转移性骨肿瘤的手术治疗

目的：探讨颈椎转移性骨肿瘤的临床表现和治疗等。方法：对29例患者（枢椎3例，下颈椎26例）的临床表现，手术适应证，外科治疗进行分析，结果：术后随访6个月－5年，1例枢椎肿瘤术后症状无改善，呼吸衰竭死亡；25例术后局部疼痛，神经根痛缓解甚至消失，神经压迫症状改善或缓解；3例患者分别于13、19、25个月后因全身多处转移、衰竭死亡，结论：颈椎转移必骨肿瘤多数患者表现为疼痛，部分患者有神经损害的表现，手术必须考虑全身情况，限于颈椎不稳，神经功能进行性损害，疼痛剧烈，或原发灶不明，手术作为明确病理诊断以指导进一步治疗的患者，根据肿瘤侵犯悦位，患者耐受手术情况，预期寿命等选择前路，后路或前后路的一期或二期手术，手术能够稳定和重建颈椎减轻或消除患者的疼痛，维持或改善神经功能，从而改善患者的生活质量。     

枢椎椎板螺钉在上颈椎后路固定术中的应用

目的探讨枢椎椎板螺钉固定术应用于上颈椎后路融合内固定术中的可行性。方法回顾性分析本院2012年1月—2014年12月在上颈椎后路融合固定术中采用枢椎椎板螺钉固定的19例患者资料,术中根据枢椎椎弓根是否存在缺如、细小等情况,选择置入双侧枢椎椎板螺钉或单侧枢椎椎板螺钉并对侧椎弓根螺钉,联合枕骨板螺钉和/或寰椎侧块螺钉。15例上颈椎畸形患者均有不同程度脊髓功能损害表现,日本骨科学会(JOA)评分为5~15分,平均11.5分。4例外伤性寰枢椎骨折患者有后颈部疼痛及活动障碍,疼痛视觉模拟量表(VAS)评分为2~7分,平均4.5分。术后复查患者影像学资料,观察内固定位置及植骨融合情况。结果所有手术顺利完成,未发生椎动脉、脊髓等损伤。术后复查CT,显示所有枢椎椎板螺钉位置良好,均未突破内侧皮质骨。随访时X线、CT示螺钉位置良好,无松动及断钉。所有患者术后12个月植骨均融合,上颈椎畸形患者神经功能均有不同程度改善,JOA评分为13~17分,平均15.3分。外伤性寰枢椎骨折患者颈部疼痛及活动障碍明显改善,VAS评分为0~2分,平均1.0分。结论枢椎椎板螺钉固定在上颈椎后路固定手术中方法简单安全、效果良好,对于无法行枢椎椎弓根螺钉固定的患者,枢椎椎板螺钉固定是一种安全有效的替代方法。     

Halo-vest在重建上颈椎稳定性中的应用

目的评价应用Halo-vest在重建上颈椎稳定性中的疗效. 方法总结1997年3月～2002年10月收治上颈椎疾患16例,年龄14～53岁.单纯Jefferson骨折3例,单纯Hangman骨折4例,AndersonⅡ型骨折1例,以上均采用Halo-vest固定3～4个半月.齿状突陈旧性骨折伴脱位行枕颈融合内固定术3例,C2、3椎体结核病灶清除植骨融合术1例,C1恶性肿瘤行后路肿瘤切除枕颈内固定1例,C2恶性肿瘤行前路肿瘤切除植骨内固定2例,颈椎管肿瘤行C2～7全椎板切除术后鹅颈畸形行前路脊髓减压植骨螺钉内固定1例,以上均采用Halo-vest术中固定,其中2例术后继续应用3个月.16例中有脊髓功能障碍者8例. 结果术后15例获6个月～5年随访.其中1例Jefferson骨折后弓愈合,前弓未愈合,拆除支架后未出现不适,颈椎活动正常;1例C2肿瘤术后8个月复发;其余均得到骨性愈合.8例脊髓功能障碍者术后均恢复正常. 结论 Halo-vest对上颈椎失稳的固定效果可靠,可用于术前、术中和术后的上颈椎稳定性重建,也是保守治疗可选用的一种有效方法.