后路椎板切除、钉棒系统内固定治疗上颈椎椎管内肿瘤

目的 探讨后路椎板切除、钉棒系统内固定及自体髂骨植骨融合术治疗上颈椎椎管内肿瘤的方法及疗效.方法 2003年1月至2008年6月,共收治上颈椎椎管内肿瘤患者16例,男10例,女6例;年龄33～68岁,平均44.7岁.硬膜外肿瘤2例,硬脊膜下脊髓外肿瘤13例,髓内肿瘤1例.肿瘤位于延髓～C1,3例,C1,28例,C2水平2例,C1-3 2例,C2,31例;其中4例肿瘤位于颈髓腹侧.15例患者行CT或MR检查示肿瘤组织压迫脊髓.Frankel分级:C级5例,D级10例,E级1例.采用后路椎板切除肿瘤,同时行钉棒系统内固定及自体髂骨植骨融合术.结果 所有患者术后均获得随访,随访时间6～58个月,平均27.4个月.根据JOA 17分法评分,术前6～17分,平均8.8分;术后6个月14～17分,平均16分,平均改善率88.1%.术后影像学检查示植骨融合良好.Frankel分级:7例由术前的D级恢复至E级,5例由C级恢复至D级,3例D级及1例E级的患者术后未改变.结论 后路椎板切除肿瘤、钉棒系统内固定及植骨融合治疗上颈椎椎管内肿瘤,可彻底切除肿瘤病灶,解除颈脊髓及神经根压迫,重建上颈椎的稳定.

Treatment of canal tumors of the upper cervical spine by posterior laminectomy and fixation screw rod system

Objective To investigate the methods and curative effects of posterior laminectomy and fixation screw rod system in treatment of canal tumors of the upper cervical spine. Methods Between Jan-uary 2003 and June 2008, 16 patients (10 males and 6 females, average age 44.7 years, range 33-68 years) with canal tumor of the upper cervical spine were treated, including epidural neoplasms in 2 cases, intradu-ral extramedullary tumors in 13, and intramedullary tumor in 1 case. The tumors were located between medulla oblongata and C1 in 3 cases, C1,2 in 8, C2 in 2, C1-3 in 2, C2,3 in 1; 4 cases were located at ventralis of cervical cord. Spinal cord was pressed by tissue of tumor in fifteen patients which were diagnosed by MRI and computerized tomographic (CT) scans. According to the Frankel grading system, there was C in 5 cases, D in 10 cases, E in 1 case. They were treated by posterior approach to remove of tumors after laminectomy, fixation with pedicle screw rod system and fusion with autogenous bone grafts. Results The follow-up was obtained for 6-58 months(mean 27.4 months). According to the JOA grading system, the preoperative average score was 8.8, 16 at 6 months postoperatively, and the average improvement rate was 88.1%. According to the Frankel grading system, 7 cases improved from D to E, 5 from C to D, but none in 3 cases with Frankel D and 1 with E. The good fusion of bone graft was found in iconography examination. Conclusion The treatment by posterior approach to remove of tumors after laminectomy, and fixation with pedicle screw sys-tem and fusion with autogenous bone grafts, can relive compression of cervical cord, nerve root, remove of tu-mor lesion thoroughly, reconstruct stabilization of the upper cervical spine and improve life quality of pa-tients.