枢椎肿瘤切除与重建技术探讨

目的：研究枢椎肿瘤的不同手术入路，肿瘤切除术及内固定重建的治疗效果。方法：对枢椎肿瘤的性质，病理类型，临床表现，各种手术途径，术式及其预后进行分析，本组18例中，骨巨细胞瘤6例，骨母细胞瘤1例，软骨肉瘤1例，骨髓瘤2例，脊索瘤2例，血管内皮细胞瘤1例，恶性淋巴瘤1例，神经纤维瘤1例，转变癌3例。5例行囊内切除，5例包膜切除，6例广泛切除，单纯枕颈后路植骨CD Cervical或Cervifix内固定术2例。结果：1例骨巨细胞瘤患进术后10d因四肢瘫痪状加重，呼吸循环衰竭死亡，1例转移癌患者术后13d因肺部感染，高热，呼吸循环衰竭死亡，术后随访6个月－4年，16例术后近期疗效较满意，局部疼痛和神经症状改善或缓解，2例转移癌患者分别于术后13个月和19个月全身多处转移，全身衰竭死亡，1例骨细胞瘤、1例软骨肉瘤术后1个局部复发。结论：应根据枢椎肿瘤具体部位，范围选择相应的手术入路和术式。肿瘤的性质，手术方式极术后综合治疗对患者预后具有重要影响。枕颈CD Cervical或Cervifix内固定术有利于保持上颈椎的稳定。

The Excision and Reconstruction Technique of Axis Tumors

Objective: To investigate the treatment effects of different surgical approach, way of tumors excision and internal fixation on atlas and axis tumors. Methods: The character, pathological types, surgical staging, clinical menifestaton of the tumors, different operative approach, opertative methods and prognosis were respectively studied. In 18 cases, 6 cases with giant cell tumor, 1 case with osteoblastomas, 1 case with chondrosarcoma, 2 cases with chordoma, 2 cases with solitary plasmacytoma, 1 case with angioendothelioma, 1 case with malignant lymphoma, 1 case with neurofibroma, 3 cases with tumor metastases. 5 cases were performed by intracapsule excision, 5 cases by marginal excision, 6 cases by wide excision,2 cases by simply occipaticervical bone graft and CD cervical or Cervifix fixation. Results: 1 case with giant cell tumor died of quadriplegia, breath and circulation failure on 10 days after operation. 1 case with metastases died of lung infection, high fever, breath and circulation failure on 13 days after operation. The following up period was from 6 months to 4 years. The recent effects after operation were satisfactory in 16 cases. The local pain and neurological symptoms were improved or resolved. 2 cases with metastases died from metastases in other multiple position, system failure in 13 months or 18 months of postoperation. Tumors focus recurred in 1 case with chondrosarcoma and 1 case with giant cell tumor in 1 year postoperation. Conclusion: The surgical approach and operative methods must be selected according to the location and region. characters of tumors, operative methods and postoperative comprehensive therapy play important roles on prognosis of the tumor cases. Occipitiocervical CD cervical or Cervifix fixation is useful for maintaining stability of upper cervical spine.