颈胸段脊柱骨肿瘤全脊椎切除与重建技术探讨(附11例报告)

目的 探讨颈胸段脊柱肿瘤前后联合入路全脊椎切除方式、内固定重建技术及其预后。方法 自1999年6月至2004年6月，对11例颈胸段脊柱（C3-T4）骨肿瘤患者实施全脊椎切除术。其中原发性骨肿瘤9例，包括骨巨细胞瘤4例，软骨肉瘤3例，动脉瘤样骨囊肿2例。转移性肿瘤2例，原发灶来源于甲状腺癌、前列腺癌各1例。经前后联合入路行单椎节切除9例、两个椎节切除2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Orion、Zephir等带锁钢板内固定，后路SUMMIT、Vertex内固定系统重建。结果术后随访1年至4年，所有患者局部疼痛和神经症状均有改善或缓解，7例患者神经功能完全恢复。1例软骨肉瘤患者术后2年局部复发，1例骨巨细胞瘤1年后局部复发，但神经功能无下降。其余患者均在进一步随访中。结论 可根据肿瘤的性质和侵犯部位、患者对手术耐受力、预期寿命等选择相应的颈胸段前后联合入路手术进行全脊椎切除术。全脊椎切除能显著降低颈胸段脊柱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。颈胸段脊柱全脊椎切除技术具有较高的难度及风险，应注意熟悉局部的解剖结构，防止或降低手术并发症的发生。

The total spondylectomy and reconstruction in the treatment of cervicothoracic spinal tumors

Objective To study the surgical indications, approaches, and the clinical results of the total spondylectomy and instrumentation reconstruction in the treatment of cervicothoracic spinal tumor. Methods From June 1999 to June 2004, 11 patients with cervicothoracic bone tumors, including 9 cases with primary tumor and 2 cases with metastatic tumor, were admitted and operated with total spondylectomy. The patients underwent anteroposterior total spondylectomy including anterior cervical plating, titanium mesh reconstruction and posterior instrumentation based on the location of tumor lesions. One vertebral level was performed with total spondylectomy in 9 cases, two level in 2 cases. Results The postoperative follow-up ranged from 1 to 4 years. 11 patients achieved good results postoperatively. 7 cases had complete relief of neurological status. One case with chondrosarcoma and one case with giant cell tumor developed local recurrence after 2 and 1 years postoperatively, respectively. Conclusions The surgical indication of the anteroposterior total spondylectomy for the cervicothoracic spinal tumor could be based on the tumorous lesion, pathological type, the medial status of the patients, and the life expectancy. Anteroposterior total spondylectomy and reconstruction can reduce local recurrence, stabilize and reconstruct the cervicothoracic spine. Meanwhile, the technique of cervicothoracic total spondylectomy carries great risks and should be performed in experienced hands. Care must be taken to protect local anatomical structures to prerent the occurrence of complication.