钛网应用于胸骨缺损修复的临床疗效分析

目的探讨钛网应用于修复胸骨缺损的可行性。方法 2012年3月～2018年12月收治的胸骨肿瘤病人9例。所有病人均在全麻下行胸骨肿瘤完整切除,并通过设计所需钛网的形状,并一期完成胸骨缺损的修复。结果无围术期死亡;手术时间130～175分钟,术中出血量100～240 ml。合并切除部分锁骨或锁骨头3例,切除局部受侵肺1例;合并胸腺切除1例,合并胸大肌肌皮瓣移植2例,其余均采用手术切口周围软组织直接缝合覆盖胸壁。术后限制肩关节活动,避免固定松动。术后5～7天拔除胸壁引流管,复查切口无感染,可见胸壁完整稳定,无胸壁浮动和反常呼吸;胸片显示钛网与骨性胸廓固定情况良好。术后发生肺部感染1例,胸腔积液1例,均予以保守治疗后痊愈。术后病理切缘阴性。结论钛网对胸骨肿瘤切除后重建胸壁塑形效果较好,手术操作简单,并发症少。     

钛板联合Teflon补片重建胸骨肿瘤切除后胸廓

目的探讨胸骨肿瘤切除术后采用钛板联合Teflon补片重建胸廓的方法及疗效。方法 2006年10月-2009年11月,收治4例胸骨肿瘤患者。男2例,女2例;年龄30～55岁。以胸部肿块、疼痛1～6个月后入院。检查见胸前区范围为4 cm×3 cm～10 cm×8 cm的肿块,质硬。CT检查见骨质破坏。采用胸骨肿瘤扩大切除术,切除范围为10 cm×8 cm～18 cm×14 cm,采用钛板联合Teflon补片重建胸廓。结果患者手术均顺利完成。术后切口Ⅰ期愈合,未出现反常呼吸、皮下气肿、气胸、感染等并发症。术后6个月1例失访,1例术后25个月因颅内出血死亡;余2例分别获随访1年及4年,肿瘤未见复发。所有患者胸壁塑形良好,随访期间钛板无松动、外露,无呼吸困难、胸闷、胸痛等不适。结论胸骨肿瘤切除后采用钛板联合Teflon补片重建胸廓,具有手术操作简便、塑形效果满意、术后并发症少等优点。     

毛囊单位移植在皮肤创面修复中的应用

目的:探讨毛囊单位移植在皮肤创面修复中的应用效果。方法:创面采用毛囊单位移植方法进行治疗,应用EQ-5D问卷,评估术前及术后12个月患者生活质量。结果:本研究共治疗创面9例,均采用毛囊单位移植技术治疗创面,术后无严重并发症,创面完全愈合。术前EQ-5D问卷总分为(0.24±0.11)分低于术后的(0.80±0.05)分,术前EQ-5D直观模拟评分量表得分(Visual analogue scale,VAS)为(78.33±6.48)分低于术后的(94.11±2.18)分,差异均具有统计学意义(P0.01)。结论:毛囊单位移植治疗创面是安全有效的方法,对提升患者生活质量具有积极意义。     

钛网异体松质骨植骨结合钛钢板内固定治疗颈椎病

目的　观察钛网容纳异体松质骨植骨结合钛钢板内固定治疗颈椎病的临床效果和放射学结果。方法　自 2 0 0 1年 4月至 2 0 0 2年 9月采用钛网容纳异体松质骨结合钛钢板固定治疗颈椎病 ,共 98例 ,其中随访 6 4例 ,平均随访时间 (15 2± 1 7)个月。按JOA评分及Nurick分级评定手术效果 ,依据X线片判断椎间稳定性和融合情况。结果　所有病例均在术后 4 8h内拔出引流条 ,无一例出现伤口或深部感染 ,伤口均一期愈合。术后JOA评分从术前的 (11 6± 1 8)分提高到 (16 0± 1 2 )分 (P<0 0 5 ) ;Nurick分级从术前的 (2 7± 0 7)级改善到术后的 (0 7± 0 8)级 (P <0 0 5 )。X线检查证实钛网无移位、脱落、下沉 ,钛钢板及螺丝钉无移位及松脱。术后 5个月 ,钛网后方开始出现新骨 ,最后随访融合率为 95 %。结论　采用钛网容纳异体松质骨同时结合前路钛钢板固定治疗颈椎病 ,短期随访观察证实能够重建颈椎稳定性     

后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤

目的探讨一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤的临床疗效。方法回顾性分析2011-07-2015-03经上述方法治疗的15例胸腰椎转移瘤临床资料。均行一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定术。观察并记录手术时间、术中失血、术后并发症、生存时间;采用VAS评分、SF-36评分、ASIA分级对患者的疼痛程度、生活质量和神经功能进行评价。结果本组患者平均手术时间(297.2±79.1)min,术中出血量(889.3±368.1)ml。术前、术后1个月、末次随访的VAS评分分别为(7.1±1.2)分、(2.1±1.0)分、(2.9±1.5)分,术后各时间点与术前比较,均具有统计学差异(P0.05)。术前神经功能ASIA分级D级2例,E级13例,末次随访E级12例,D级1例,B级2例。健康调查简表(the MOS item short from health survey,SF-36)评分术前(63.1±7.7)分,术后6个月或末次随访(生存期未达6个月者)(79.8±11.4)分,与术前比较,差异有统计学意义(P0.05)。患者中位生存时间15个月,围术期死亡1例,术后6个月内死亡3例,术后1年内死亡6例,术后2年内死亡9例,存活2年以上1例。至末次随访,共6例患者存活。结论一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建联合内固定治疗胸腰椎转移性肿瘤,可明显改善患者神经症状和生存质量,同时,可为患者争取获得更多辅助治疗的机会,达到局部病变的中长期控制。     

零切迹桥形锁定融合器与前路cage联合钛板固定治疗脊髓型颈椎病的疗效比较

目的探讨零切迹桥形锁定融合器(ROI-C)与前路cage联合钛板固定治疗双、三节段脊髓型颈椎病的疗效差异。方法回顾性分析2017年6月至2019年10月接受手术治疗的85例双、三节段脊髓型颈椎病患者的病历资料,男43例,女42例;年龄(52.3±8.0)岁(范围28~66岁);双节段63例、三节段22例。采用ROI-C治疗45例(ROI-C组),采用前路cage联合钛板固定40例(钛板组)。主要观察指标包括手术时间、术中出血量、颈椎Cobb角、融合节段Cobb角、平均椎间高度、疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分和颈椎功能障碍指数(neck disability index,NDI)。结果85例患者随访时间为(16.9±2.0)个月(范围12~22个月)。双节段ROI-C组手术时间为(110.37±8.25)min,较钛板组(139.5±10.54)min短;术中出血量为(15.74±8.10)ml,较钛板组(23.71±9.70)ml少。三节段ROI-C组手术时间为(130.00±5.70)min,较钛板组(162.83±5.59)min短;而术中出血量的差异无统计学意义。术后1年ROI-C组双、三节段颈椎Cobb角分别为15.31°±1.55°、15.20°±0.42°,优于术前11.23°±2.03°、9.20°±1.14°;钛板组为15.89°±1.13°、16.08°±1.88°,优于术前11.25°±2.01°、9.00°±1.60°;术前及术后1年两组间的差异均无统计学意义。术后1年ROI-C组双、三节段VAS评分分别为(1.83±0.66)分、(2.60±0.52)分,低于术前(7.49±0.51)分、(7.60±0.52)分;钛板组为(1.79±0.50)分、(2.41±0.51)分,低于术前(7.61±0.63)分、(7.42±0.52)分;术前及术后1年两组间的差异均无统计学意义。术后1年ROI-C组双、三节段JOA评分分别为(15.00±0.84)分、(14.70±0.95)分,优于术前(7.20±0.87)分、(6.60±1.27)分;钛板组为(15.29±0.85)分、(14.83±0.58)分,优于术前(6.89±1.03)分、(6.92±0.67)分;术前及术后1年两组间的差异均无统计学意义;两组术后JOA改善率均为优。ROI-C组术后发生吞咽困难1例(2.22%,1/45),钛板组发生吞咽困难8例(20.00%,8/40),发生率的差异有统计学意义(χ2=5.32,P=0.02)。结论ROI-C与前路cage联合钛板固定治疗双、三节段脊髓型颈椎病均可取得良好的近期临床疗效,但采用ROI-C手术时间较短、术后吞咽困难发生率低。     

微型钛板改良单开门颈椎管扩大成形术治疗脊髓型颈椎病的临床效果

【摘要】〓目的〓评价微型钛板改良单开门颈椎管扩大椎板成形术治疗脊髓型颈椎病的临床效果。方法〓2008年1月~2012年2月,观察46例多节段脊髓型颈椎病(MCSM)行微型钛板改良单开门颈椎管扩大椎板成形术的脊髓型颈椎病患者,对比术前及术后JOA评分,在CT上测量C5节段椎管术前、术后6个月的矢状径,计算椎管扩大率[(术后椎管矢状径-术前椎管矢状径)/(术前椎管矢状径)×100%],观察单开门门轴侧骨融合情况。结果〓平均随访18个月(6~24个月)。术前平均JOA评分8.2分,术后平均JOA评分14.8分。C5节段椎管矢状径术前为8.6±1.1 mm,术后6个月为16.1±0.9 mm,椎管扩大率为(74.3±14.4)%。术后6个月,可以观察到单开门门轴侧骨融合,无螺钉松动及再“关门”现象。结论〓微型钛板改良单开门椎管成形术治疗脊髓型颈椎病临床效果满意,防止再关门。     

TightRope钛板治疗Rockwood Ⅲ型肩锁关节脱位

目的探讨TightRope钛板治疗RockwoodⅢ型肩锁关节脱位的临床效果。方法对17例RockwoodⅢ型肩锁关节脱位患者采用TightRope钛板治疗,参照肩关节Karlsson和Constant-Murley评定标准进行疗效评估。结果患者均获得随访,时间6~12个月。术后6个月根据Karlsson评定标准评价:优良11例,满意6例;Constant-Murley肩关节功能评分总分由术前(44.65±6.63)分提高至(89.52±3.87)分,其他各项评分均优于术前,差异均有统计学意义(P0.01)。结论 TightRope钛板治疗RockwoodⅢ型肩锁关节脱位具有创伤小、切口美观、患者功能恢复良好的优点。     

颈椎硬膜内髓外肿瘤手术治疗方式选择

目的 探讨颈椎硬膜内髓外肿瘤的手术方式及钛网椎管重建的效果.方法 2002年3月至2008年9月手术治疗颈椎硬膜内髓外肿瘤26例,男14例,女12例;年龄6～76岁,平均38岁.术前神经功能Frankle分级,B级3例,C级8例,D级11例,E级4例.16例行半椎板切除(半椎板组),10例全椎板切除后行钛网椎管重建(全椎板组).术后随访6个月～5年,平均26个月,记录术后神经恢复及植骨融合情况.确认植骨融合后(术后6个月),对半椎板组和全椎板组病例手术前后的颈椎曲度指数、颈椎活动度进行评估.结果 术后神经功能恢复Frankle分级均有改善.术前Frankle分级B级3例,术后提高到C级;术前C级8例提高到D级;术前D级11例提高到术后E级10例、D级1例.全椎板组钛网表面植骨块与上、下椎板融合,术后脊柱稳定,未发生畸形.半椎板组术后颈椎曲度指数丢失2.2±2.3,全椎板组术后颈椎曲度指数丢失4.3±2.5,两组患者手术前后颈椎曲度变化的差异有统计学意义(t=2.05,P＜0.05).半椎板组术后颈椎活动度丢失1.3°±1.2°,全椎板组患者术后颈椎活动度丢失9.2°±4.1°,两组差异有统计学意义(t=1.71,P＜0.05).结论 颈椎硬膜内髓外肿瘤体积小位于椎管一侧,适宜选择半椎板切除.对于需要行全椎板切除的病例,内固定及钛网椎管重建加植骨,可以重建脊柱的稳定性.     

Arch钛板与侧块螺钉固定治疗颈椎后纵韧带骨化症疗效比较

目的探讨Arch钛板固定与侧块螺钉钛棒固定在治疗颈椎后纵韧带骨化症中的疗效比较。方法 2012年3月至2016年3月,徐州医科大学附属医院骨科对33例行后路单开门椎管扩大成形术治疗颈椎后纵韧带骨化症的患者进行回顾性分析,并获得随访患者的临床资料,其中应用侧块螺钉固定的患者18例,应用Arch钛板固定的患者15例。依据不同手术方法分为侧块螺钉组和Arch钛板组。比较两组患者手术前后JOA评分(17分法)、术前及术后6个月C4节段椎管矢状径,术后3d和术后6个月的开门角度及开门角度丢失情况,术前和末次随访SF-36生活质量及颈椎活动度评测。以JOA评分及其改善率评价术后神经功能改善情况;术后复查颈椎X线片、CT及MRI,在术后6个月颈椎CT片上测量C4节段椎管矢状径,计算椎管扩大率及开门角度,评价门轴侧骨性愈合情况;记录所有术中及术后并发症。结果随访时间6~24个月。侧块螺钉组,手术时间(143.06±22.44)min,术中出血量(256.95±32.23)mL。Arch钛板组,手术时间(130.67±21.03)min,术中出血量(238.67±27.02)mL。两组手术时间及术中出血量比较,差异均无统计学意义(P0.05)。侧块螺钉组JOA评分:术前为(8.39±2.38)分,术后6个月为(12.00±2.20)分,JOA评分改善率(44.16±14.68)%。Arch钛板组JOA评分:术前为(8.53±2.70)分,术后6个月为(14.07±2.31)分,JOA评分改善率(68.56±15.73)%。两组患者JOA评分改善率比较,差异有统计学意义(P0.01)。侧块螺钉组C4节段椎管矢状径:术前为(6.20±1.26)mm,术后6个月为(10.31±2.15)mm。Arch钛板组C4节段椎管矢状径:术前为(6.39±1.39)mm,术后6个月为(12.43±3.19)mm。两组患者术前C4节段椎管矢状径比较,差异无统计学意义(P0.05),术后比较差异有统计学意义(P0.05)。侧块螺钉组术后6个月椎管开门角度为(25.57±3.95)°,Arch钛板组为(29.67±4.16)°。两组患者开门角度、开门角度丢失比较,差异有统计学意义(P0.01)。两组患者末次随访SF-36生活质量评分、颈椎活动度比较,差异有统计学意义(P0.01)。侧块螺钉组术后发生再关门现象1例,发生轴性症状5例,对症治疗后缓解。Arch钛板组术后无再关门现象及轴性症状发生。两组患者均无内固定弯曲、断裂现象。术后6个月MRI检查见脊髓受压明显缓解。结论在单开门颈椎管扩大成形术中,相对于侧块螺钉固定,Arch钛板固定的手术时间及术中出血量差异无统计学意义,术后JOA改善率及椎管扩大效果均优于侧块螺钉固定,而且可以有效避免轴性症状及再关门现象的发生,保留了颈椎活动度,是治疗颈椎后纵韧带骨化症的一种安全、有效的方法,早期临床疗效满意。     

Anterior chest wall reconstruction with titanium plate sandwiched between two polypropylene sheets

Extensive sternal resection carries the risk of difficult reconstruction and surgical complications. A 79-year-old woman underwent sternal resection and reconstruction for sternal chondrosarcoma. However, 18?months after the first operation, she developed six metastatic tumors on the anterior chest wall. She underwent subtotal sternectomy and rib resection, leaving a defect measuring 17?×?14?cm. Reconstruction of the anterior chest wall using a titanium plate sandwiched between two polypropylene mesh sheets is described. This method is potentially applicable to extensive anterior chest resection, and its advantages compared with conventional prostheses are rigidity, flexibility, and usability.     

颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症

目的探讨颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症的疗效。方法对确诊为颈椎管狭窄症患者62例,采用颈前路椎体次全切除钛网植骨钢板固定,对比手术前后患者的JOA评分,分析术前、术后及随访时的动力位片,观察钛网、钢板的位置及颈椎前凸角的变化。结果获得完整随访的患者42例,术后随访6～48个月（平均24个月）,6～8个月均获得植骨融合。术后颈椎前凸角改善明显,钛网及钢板位置稳定,JOA评分在术后获得较显著提高（P〈0.05）。结论颈椎椎体次全切除钛网钢板固定治疗颈椎管狭窄症近期疗效肯定,是一种值得推广的术式,但该术式应严格掌握其适应证。     

经后侧入路前方减压钛网植骨重建短节段椎弓根内固定治疗腰椎爆裂骨折的临床效果

目的探讨后侧入路环形减压钛网植骨短节段重建治疗腰椎爆裂骨折的临床效果。方法 2008年1月~2012年6月采用一期后路椎体次全切除钛网重建短节段椎弓根螺钉内固定治疗不稳定腰椎爆裂骨折19例,其中L1 6例,L3 4例,L4 9例,患者平均年龄65(42~78)岁。均存在下肢神经功能障碍或严重腰背痛,Frankel神经功能分级:B级9例,C级7例,D级3例。腰背痛或腿痛采用视觉模拟量表(visual analogue scale,VAS)进行疼痛评分。脊柱节段性不稳采用LSS标准评估。采用侧位X线片测量损伤节段的后凸角。随访中还对患者的螺钉松动、钛网移位,重建角度丢失等情况进行记录。结果本组手术时间216~408 min,平均(277.8±124.2)min,失血量220~701 ml,平均(471.8±238.6)ml,无一例患者术中或术后输血。围手术期未见脑脊液漏、医源性神经功能损害、切口感染、深静脉血栓栓塞、肺栓塞等并发症发生。所有患者均获随访,时间18~60个月,平均(39.2±10.9)个月。术后3个月1例患者发生钛网移位,但未出现明显重建角度丢失,亦未发生螺钉松动、内固定失败等情况,术后1年随访椎间融合良好。术前、术后3 d及末次随访时腰腿疼痛VAS评分分别为(7.5±1.5)分、(1.1±0.9)分和(1.0±0.8)分,后凸角分别为15.7°±6.9°,-5.0°±11.6°和-4.7°±12.9°,术前与术后各时间点VAS评分及后凸角比较,差异具有统计学意义(P0.05),但术后3 d与末次随访之间差异均无统计学意义(P0.05)。至末次随访时,所有患者其Frankel分级均获得1~2级恢复。结论一期后路椎体次全切除钛网重建短节段椎弓根螺钉内固定治疗不稳定腰椎爆裂骨折安全、有效,并发症发生率低。     

Resection of Sternal Tumors and Reconstruction of the Thorax: A Review of 15 Patients

Purpose We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. Methods Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. Results All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. Conclusions Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.     

A case report on a full-thickness chest wall reconstruction with polypropylene mesh and stainless steel mesh concurrently using a transverse rectus abdominis myocutaneous flap.

A full-thickness chest wall resection requires subsequent chest wall reconstruction. A chest wall resection and reconstruction was performed using a transverse rectus abdominis myocutaneous (TRAM) flap, together with polypropylene mesh (Marlex mesh) and stainless steel mesh (SSM). A 71-year-old man was diagnosed as having recurrent lung cancer in the chest wall, and underwent surgical resection. Marlex mesh was sutured to the posterior wall of the surgical defect. A portion of the SSM was adjusted to the size of the defect and cut out. Its edges were folded to make the portion into a plate. This SSM plate was placed anteriorly to the Marlex mesh and sutured to the ribs. The Marlex mesh was folded back on the SSM plate by 2 cm and fixed. After the above procedures, a left-sided TRAM flap was raised through a subcutaneous tunnel up to the defect and sutured to the region. The patient was discharged from hospital 19 days postoperatively. The wound was fine and he had no flail chest or dyspnea, and carcinomatous pain resolved.     

Problems in resection of chest wall sarcomas.

To illustrate the problems of reconstruction in major chest wall resection, five patients with a variety of soft tissue tumors of the chest wall, located at different sites, are presented. Patients, who underwent a lateral or posterolateral chest wall resection required removal of two to five ribs sequentially as well as the adjacent soft tissue. Those who underwent an anterior chest wall resection required resection of the manubrium or the body of sternum as well as of adjacent costal cartilages. To prevent instability of the chest, herniation, and to minimize flailing, the chest defect was bridged with the use of Marlex mesh. Whenever possible, the omentum was brought into the chest cavity to increase the vascularity of the reconstruction. Since, in most instances, the tumors involved the skin because of previous damage from radiation therapy, extensive skin coverage was planned well in advance of resection. Pedicle skin flaps or rotation flaps were used to cover the skin defect. Ventilatory support by volume respirator, was required for three to four days. In all patients, the chest wall was completeley stable after three to six weeks.     

Clear cell chondrosarcoma arising from the sternum: a rare tumor in an uncommon location

A 52-year-old woman presented with bulging of the anterior chest wall. The computed tomographic scan revealed an expansive localized mass based on the sternal manubrium. The patient was successfully treated with en bloc radical resection and reconstruction with clear resection margin. Histopathologic examination of the surgical specimen confirmed the diagnosis of clear cell chondrosarcoma. After the surgery, the patient has been free of disease for 43 months after surgery without other treatment. Our search and review of the literature did not reveal any published cases of clear cell chondrosarcoma arising from the sternum; therefore, we have presented a summary of this novel case with a review of the relevant literature.     

Malignant fibrous histiocytoma of the rib: a case report of repetitive extensive resections and reconstruction of the chest wall

A forty-seven-year-old woman visited our hospital in March 1987 suffering from the local recurrence of the tumor. Her right 7th and 8th rib had been resected 2 years and 11 months before because of the malignant fibrous histiocytoma (MFH) originated from the right 7th rib. In May 1987, wide resection of the right lateral chest wall and partial resection of the right diaphragm were done. Dacron meshed silicon plate (Silastic) and musculocutaneous flap of the right latissimus dorsi were used to reconstruct the chest wall. Seven months after the second operation, local recurrence occurred again on the anterior chest wall, involving the right diaphragm and right lower lobe of the lung. In March 1988, extensive resection of the anterior chest wall with partial resection of the right diaphragm and the right lower lobe was followed by reconstruction of the chest wall by Silastic. The patient recovered uneventfully without any respiratory disturbances after both operations which included wide resection of the chest wall. Multiple pulmonary metastases were found 4 months after the operation, and she died of respiratory failure 7 months after the final operation. Although MFH was one of the most common sarcomas of the soft tissues, only one case of the MFH originated from the rib had been reported previously in this country. Silastic was proved to be a useful prosthesis for the reconstruction of widely resected chest wall.     

Completely wide resection of malignant fibrous histiocytoma of the chest wall; expect for long survival.

Malignant fibrous histiocytoma (MFH) rarely occurs in the chest wall. A case of MFH originating from the chest wall is herein reported. We performed radical en-block resection of the whole chest wall together with the tumor and reconstructed it with Marlex mesh. There was no recurrence 4 years after operation. We consider radical en-block resection for MFH and reconstruction with Marlex mesh a safe operation and may provide a long-term survival.     

经颌下入路切除枢椎肿瘤及前方内固定应用

目的 探讨经颌下胸锁乳突肌内侧缘入路切除枢椎肿瘤及前方内固定的应用.方法 2004年12月至2010年6月,采用经颌下胸锁乳突肌内侧缘入路联合后路行枢椎肿瘤切除前后内固定术治疗枢椎肿瘤17例,男11例,女6例;年龄23～77岁,平均49岁;C2 11例,C2.34例,C2-42例;8例累及椎体,9例累及椎体及附件.原发性肿瘤14例,其中骨巨细胞瘤4例,浆细胞瘤4例,脊索瘤2例,嗜酸性肉芽肿2例,血管外皮瘤、淋巴瘤各1例;转移性肿瘤3例.前路肿瘤切除后采用钛网植骨及钛板垂直放置螺钉固定、钛网植骨及钛板斜行放置螺钉固定、钛网修剪后植骨螺钉固定3种方式行上颈椎前路内固定,均一期联合后路肿瘤切除枕颈内固定.结果 术后患者局部疼痛缓解,神经症状减轻或消失.术后随访6个月至6年.1例采用钛网植骨及钛板垂直放置螺钉固定的患者术后1个月发生螺钉松动退出,经翻修后融合,余16例患者均获融合.1例患者于术后9个月死于脑梗死.2例脊索瘤患者分别于术后13和18个月局部复发,1例死于高位瘫痪、呼吸衰竭,1例带瘤生存.2例转移癌患者分别于术后12和18个月因全身多处转移、衰竭而死亡.结论 经颌下胸锁乳突肌内侧缘入路可获得枢椎肿瘤切除与重建的良好显露.应用颈椎内固定系统可实现枢椎肿瘤切除后上颈椎稳定的前方重建.

Abstract：

Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.