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目的:探讨前路内窥镜辅助下经颈动脉三角C1～C2肿瘤切除、稳定性重建和后路内固定的手术特点以及临床治疗效果。方法:2006年1月～2009年12月收治8例上颈椎肿瘤患者,男性5例,女性3例,年龄16～51岁,平均35.6岁。枕颈部疼痛不适5例,合并神经症状3例(Frankel分级C级1例,D级2例)。均以枢椎椎体破坏为主,同时累及枢椎后柱者3例,累及寰椎前弓者1例。浆细胞瘤3例,转移癌2例,骨软骨瘤1例,嗜酸性肉芽肿1例,动脉瘤样骨囊肿1例。采用一期后路内固定植骨联合前路内窥镜辅助下肿瘤切除自体髂骨植骨重建,术后良性病变患者定期随访观察,原发恶性肿瘤及转移癌患者行辅助放疗或化疗。对所有患者临床资料进行回顾性分析。结果:围手术期无严重并发症发生。随访9个月～4年,平均24个月,CT证实植骨获得满意融合。3例术前伴有神经功能损害者末次随访时Frankel分级各改善1级。1例转移癌患者于术后11个月时死于肺癌,另1例转移癌患者术后9个月复发并出现多个椎体转移,1例浆细胞瘤患者术后17个月随访时转为多发性骨髓瘤,其余5例患者未见肿瘤复发或转移。结论:前路内窥镜辅助下切除上颈椎肿瘤、稳定性重建并后路内固定能够在一定程度上克服传统手术显露困难的缺点,减少手术并发症,但如何完成肿瘤一期彻底或整块切除还有待进一步研究。
Objective: To investigate the surgical characteristics and clinical effects of resection, stability reconstruction and posterior fixation of carotid artery C1-C2 tumors assisted by anterior endoscope. Methods: From January 2006 to December 2009, 8 patients with upper cervical cancer were enrolled. There were 5 males and 3 females, aged from 16 to 51 years (average 35.6 years). Sleeve neck pain discomfort in 5 cases, 3 cases of neurological symptoms (Frankel C grade in 1 case, D grade in 2 cases). Axis were the main vertebral destruction, involving both posterior column in 3 cases, involving atlantoaxial bow in 1 case. 3 were plasmacytoma, 2 were metastatic carcinoma, 1 osteochondroma, 1 acidophilic granuloma and 1 aneurysmal bone cyst. A one-stage internal fixation with bone grafting combined with anterior endoscopic assisted resection of autologous iliac bone graft reconstruction, regular follow-up of benign lesions in patients with primary malignant and metastatic cancer patients undergoing adjuvant radiotherapy or chemotherapy. The clinical data of all patients were retrospectively analyzed. Results: Perioperative no serious complications occurred. The follow-up ranged from 9 months to 4 years, with an average of 24 months. CT showed satisfactory fusion of the bone graft. Three cases with preoperative neurological deficits were improved Frankel grading at the last follow-up. One patient with metastatic disease died of lung cancer at 11 months after operation. One patient with metastatic disease recurred 9 months after operation and had multiple vertebral metastases. One patient with plasmacytoma was followed up for 17 months For multiple myeloma, the remaining 5 patients no tumor recurrence or metastasis. Conclusion: The anterior endoscopic assisted resection of cervical spine tumors, stability reconstruction and posterior fixation can overcome the shortcomings of the traditional surgical difficulties, to reduce the surgical complications, but how to complete a complete or a single tumor Excision remains to be further studied.