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目的探讨一期后外侧入路治疗Ⅲ期颈椎椎管内外哑铃形肿瘤的临床疗效。方法回顾性分析2006年1月—2013年12月第二军医大学附属长征医院骨肿瘤科收治的91例长征医院外科分期系统Ⅲ期的颈椎椎管内外哑铃形肿瘤患者的临床资料。所有患者均采用一期后外侧入路(后外侧肌间隙入路+侧块切除)钉棒/钉板系统内固定植骨融合术治疗,采用疼痛视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)及美国脊髓损伤协会(ASIA)分级观察患者临床症状改善和神经功能恢复情况。结果所有患者手术均顺利完成。手术时间(2.7±1.3)h,出血量(550±110)m L。所有患者术中无大血管、神经损伤,术后27例发生脑脊液漏,1例术后出现左上肢一过性肌力下降,1例右侧颈后部麻木加重,1例发生霍纳综合征,1例术中因左侧椎动脉撕裂而行椎动脉修补术。术后无伤口深部感染,仅1例术前曾放疗的患者术后伤口愈合不佳。术后VAS评分和NDI均较术前明显降低,差异有统计学意义(P<0.05)。91例患者的颈部疼痛症状消失,88例患者神经功能有不同程度恢复和改善,49例患者脊髓神经功能完全恢复。随访8~91(72.0±3.1)个月,末次随访时除2例死亡,其余均获得骨性融合。结论一期后外侧入路治疗Ⅲ期颈椎椎管内外哑铃形肿瘤疗效肯定,术后局部复发率和手术并发症发生率低,内固定重建对维持颈椎的稳定性具有重要价值。
Objective To investigate the clinical effect of one-stage lateral approach for the treatment of stage Ⅲ cervical spinal dumbbell tumor. Methods The clinical data of 91 patients with dumbbell tumors of the cervical vertebral canal from 91 patients with Changzheng Hospital undergoing surgical staging system Ⅲ from January 2006 to December 2013 in Changzheng Hospital, Second Military Medical University were retrospectively analyzed. All patients were treated with one-stage posterolateral approach (posterolateral myenteric approach + lateral block excision) and internal fixation with bone graft fusion. Pain visual analog scale (VAS) score, cervical vertebral dysfunction Index (NDI) and American Society of Spinal Cord Injury (ASIA) grading the clinical symptoms and neurological recovery. Results All patients underwent surgery successfully. The operation time (2.7 ± 1.3) h, the amount of bleeding (550 ± 110) m L. All patients had no major blood vessels and nerve injury during operation, cerebrospinal fluid leakage occurred in 27 patients after operation, left anterior muscle weakness occurred in one patient, numbness of right posterior neck increased in 1 patient, and Horner’s syndrome in 1 patient , 1 case of intraoperative left vertebral artery torn line vertebral artery repair. No postoperative deep wound infection, only 1 patient who had radiotherapy before surgery wound healing poor. Postoperative VAS score and NDI were significantly lower than preoperative, the difference was statistically significant (P <0.05). The symptoms of neck pain disappeared in 91 patients, and the neurological function of 88 patients recovered and improved to some extent. The spinal cord nerve function of 49 patients recovered completely. All the patients were followed up for 8 to 91 months (72.0 ± 3.1). Two patients died at the final follow-up, and the rest achieved bony fusion. Conclusion The treatment of stage Ⅲ cervical spinal dumbbell tumor with lateral approach is effective after the first phase, and the local recurrence rate and the incidence of surgical complications are low. Internal fixation reconstruction is of great value in maintaining the stability of cervical vertebra.