|摘要||目的 总结寰枢椎肿瘤手术显露和彻底切除的方法,评价异形钛网植骨融合内固定在寰枢椎肿瘤切除术后枕颈稳定性重建中的作用和价值.方法 2005年3月至2007年8月手术治疗6例寰枢椎肿瘤患者,男3例,女3例;年龄17～70岁,平均43.7岁;脊索瘤4例,骨巨细胞瘤1例,骨纤维异常增殖症1例.病变累及所有患者的椎体及侧块或后方结构.全部采用前方颌下颈动脉三角入路联合后方枕颈入路,按照"无瘤操作"的原则行病椎全脊椎切除,前路行异形钛网植骨融合内固定,后路行枕颈固定术,同时行Halo-vest架外固定,术后随访6～16个月.结果 C1.2切除1例,C2.3切除2例,C2切除3例.平均手术时间7.2h,平均术中出血量2400 ml.所有患者局部疼痛和神经症状减轻或消失,未出现神经、血管损伤,1例脊索瘤患者术后1年出现局部复发.至末次随访时所有患者头部位置良好,均达到枕颈区稳定,未出现内固定松动、断裂和移位.结论 按"无瘤操作"的原则行包膜外肿瘤切除可以获得较好的疗效;异形钛网植骨融合内固定术结合枕颈固定术,同时辅以Halo-vest架外固定,可以提高手术的安全性,并能在寰枢椎肿瘤切除术后有效地重建上颈椎的稳定性,实现即刻稳定,便于患者早期下床活动,提高患者生活质量,且手术操作简便易行,适合在寰枢椎肿瘤切除术中应用.
Objective To summarize the techniques for atlantoaxial tumors exposure and radical excision, and to evaluate the clinical effects of internal fixation by special formed titanium mesh in upper cervical spine stability reconstruction after atlantoaxial tumors resection. Methods From Mar. 2005 to Aug. 2007, 6 patients (3 males, 3 famales)with atlantoaxial tumors were treated in our hospital, including 4 cases with chordoma,1 case with bone giant cell tumor, 1 case with bone fibrous hyperplasia. Vertebral body and lateral mass or posterior structure were involved in these 6 patients. All the paitents underwent total vertebra resection according to "tumor free operating" principle by anterior submandibular carotid triangle approach firstly and posterior occipito-cervical approach secondly, and were fixed internally by special formed titanium mesh anteriorly and occipito-cervieal fixation posteriorly, Halo-vest fixed externally. All patients were fol-lowed up for 6-16 months. Results One case underwent C12 resection, 2 cases for C23, 3 cases for C2. Op-eration time was 7.2 hours in average, bleeding volume was 2400 ml in average. Local pain and neurological symptoms of all patients were improved or resolved. No complications of blood vessel and nerve injury. Tu-mor focus recurred in 1 case with chordoma 1 year after operation. All patients had good head position and occipito-cervical stability, no internal fixation failure happened. Conclusion Tumor resection beyond the capsule of lesion according to "tumor free operating" principle can obtain good clinical results. Internal fixa-tion by special formed titanium mesh with occipito-cervical fixation and Halo-vest external fixation assisted, can improve safety in operation, reestablish stability effectively after tumor resction in the upper cervical spine, and provide immediate stabilization, which has the advantages in easy manipulation, early function ex-ercises, is a good method for stability reconstruction of upper cervical spine.|