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。

Cervical stability reconstruction after resection of one side facet joints in patients with cervical spine tumor

Objective:To study the cervical stability reconstruction after resection of one side facet joints in patients with cervical spine tumor.Method:From 1999 to 2005,eighteen patients with cervical spine tumor undergoing resection of one side facet joints followed by cervical stability reconstruction were followed-up retrospectively.There were 10 males and 8 females,with the age range of 16~72 years old(average,46 years old). Clinical manifestation included:radicular spondylosis(RS) in 10 cases with the VAS grade of 2~8(average 4.2),ervical myelopathy(CM) in 8 cases with the ASIA grade C in 5 cases,D in 3 cases.All cases underwent posterior resection of unilateral facet joints,tumor resection en bloc and lateral mass plate fixation(unilateral mass plate fixation in 10 cases,bilateral mass plate fixation in 8 cases).Result:All cases were followed up for 3~60 months(average,20 months),1 case died of pneumono-metabasis,others were alive with no tumor recurrence.During the follow-up period,10 cases complained of RS had the VAS grade of 0~4(average,1.6); of 8 cases complained of CM,3 cases with grade C before operation progressed into grade E,1 case with grade D before operationprogressed into grade E.4 cases had bony fusion after bilateral mass plate fixation fusion at 3rd month of follow-up,and 7 cases were evidenced bony fusion at 6rd month of follow-up,no instrument failure or cervical spine unstability were noted in 7 months.For cases undergoing unilateral mass plate fixation,9 cases had bony fusion after 9 month,screw loosening was noted in 1 case after 12 month due to fusion failure,who complained of cervical pain.Conclusion:For cervical spine tumor necessitating removal of one side facet joints,posterior bilateral mass plate fixation is superior than unilateral mass fixation biomechanically.