原发性颈胸段脊柱肿瘤的临床特点与外科治疗

目的研究颈胸段脊柱肿瘤的临床特点、诊断、手术入路、肿瘤切除术式、前路植骨、钛网、Orion/Zephier或AO钢板内固定重建的治疗效果.方法分析本院1998年1月～2001年12月期间收治的33例原发性颈胸段脊柱肿瘤的病理类型、临床表现、诊断、各种手术途径、术式及其预后.结果本组33例中骨巨细胞瘤14例,骨髓瘤8例,嗜酸性肉芽肿4例,软骨肉瘤3例,恶性淋巴瘤2例,恶性神经鞘瘤1例,骨软骨肉瘤1例.肿瘤切除方式囊内切除11例,包膜切除13例,广泛切除9例.根据肿瘤的病理类型,术后给予相应的放疗或化疗.术后随访6～48个月.术后近期疗效均较满意,32例患者术后神经功能均有不同程度的改善.1例T1～T2骨巨细胞瘤和1例软骨肉瘤患者分别于囊内切除术后8个月、13个月局部复发,1例软骨肉瘤患者于囊内切除术后24个月因肺部转移,全身衰竭死亡.结论根据其临床特点和影像学检查可确定诊断.根据肿瘤的部位、性质、范围选择相应的手术途径及肿瘤切除方式,前路植骨、钛网、Orion或AO钢板内固定术有利于颈胸段脊柱稳定性重建.

Clinical Characteristics and Surgical Treatment of Primary Tumors of Cervicothoracic Junction

Objective:To investigate the clinical charac te ristics,diagnosis,different anterior surgical approaches of cervicothoracic junc ti on and therapy effects of tumors excision procedure,reconstruction of bone graft ,cylindrical titanium mesh,Orion or AO plate fixation.Methods:The oncologic type s ,clinical manifestation,diagnosis,different operative approaches,surgical proced ur e and prognosis of 33 cases from Jan.1998 to Dec.2001 were analyzed.Results:In 3 3 cases enrolled,14 cases with giant cell tumor,8 ceses with solitary myelocytoma,4 cases with eosinophilic granuloma,3 cases with chondrosarcoma,2 ca ses with Hodgkin's lymphoma,1 case with maligment neurofibroma,1 case with os teochondr osarcoma.Eleven cases were performed by intracapsule excision,13 cases by margin al excision,9 cases by wide excision.The related radiotherapy and chemical therapy were underwent according to oncologic types.The following up period were from 6 t o 48 months.The recent effects of postoperation were satisfactory in all cases.S pinal cord neurological function were improved in 32 cases with different degree s.Tumor local recurred in 1 case with giant cell tumor 8 months after intracapsu le excision and l case with chondrosarcoma in 13 months,and died of metastases i n lung and systematic failure 24 months after operation.Conclusion:The diagnosis could be confirmed by clinical characteristics and image behavior.The relative operative approach and surgical procedure should be selected according to the tumors nature,location and range.Anterior bone gra ft,cylindrical titanium mesh,Orion or AO plate fixation are very useful for rec onstruction of cervicothoracic spine stabilization.