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1、摘要是原来发表时已经翻译好的！后路椎板切除、钉棒系统内固定治疗上颈椎椎管内肿瘤Treatment of canal tumors of the upper cervical spine by posterior laminectomy and fixation screw rod system【摘要】目的探讨后路椎板切除、钉棒系统内固定及自体髂骨植骨融合术治疗上颈椎椎管内肿瘤的方法及疗效。方法2003年1月至2008年6月，共收治上颈椎椎管内肿瘤患者16例，男10例，女6例；年龄33-68岁，平均44.7岁。硬膜外肿瘤2例，硬脊膜下脊髓外肿瘤13例，髓内肿瘤1例。肿瘤位于延髓-C1，3例，C1
2、,2 8例，C2水平2例，C1-3 2例，C2,3 l例；其中4例肿瘤位于颈髓腹侧。15例患者行CT或MR检查示肿瘤组织压迫脊髓。Frankel分级：C级5例，D级10例，E级1例。采用后路椎板切除肿瘤，同时行钉棒系统内固定及自体髂骨植骨融合术。结果所有患者术后均获得随访，随访时间8个月，平均27.4个月。根据JOA 17分法评分，术前争6-17分，平均88分；术后6个月14-17分，平均16分，平均改善率881。术后影像学检查示植骨融合良好。Frankel分级：7例由术前的D级恢复至E级，5例由C级恢复至D级，3例D级及l例E级的患者术后未改变。结论后路椎板切除肿瘤、钉棒系统内固定及植骨融合
3、治疗上颈椎椎管内肿瘤，可彻底切除肿瘤病灶，解除颈脊髓及神经根压迫，重建上颈椎的稳定。【关键词】颈椎；椎管；肿瘤；内固定器【Abstract】Objective To investigate the methods and curative effects of posterior laminectomy and fixation screw rod system in treatment of canal tumors of the upper cervical spineMethods Between January 2003 and June 2008，16 patients(10 mal
4、es and 6 females，average age 44.7 years，range 33-68 years)with canal tumor of the upper cervical spine were treated，including epidural neoplasms in 2 cases,intradural extramedullary tumors in 13, and intramedullary tumor in l caseThe tumors were located between medulla oblongata and C1 in 3 cases，C1
5、,2 in 8，C2 in 2，Cl-3 in 2，C2,3 in l；4 cases were located at ventralis of cervical cordSpinal cord was pressed by tissue of tumor in Fifteen patients which were diagnosed by MRI and computerized tomographic(CT)scansAccording to the Frankel grading system，there Was C in 5 eases，D in 10 casesE in l cas
6、eThey were treated by posterior approach to remove of tumors after laminectomy，fixation with pedicle screw rod system and fusion with autogenous bone graftsResults The follow up was obtained for 6-58 months(mean 27.4 months)According to the JOA grading system，the preoperative average score was 8.8，1
7、6 at 6 months postoperatively, and the average improvement rate was 88.1According to the Frankel grading system，7 cases improved from D to E，5 from C to D，but none in 3 cases with Frankel D and l with EThe good fusion of bone graft Was found in iconography examinationConclusion The treatment by post
8、erior approach to remove of tumors after lamineetomy，and fixation with pedicle screw system and fuIsion with autogenous bone grafts，can relive compression of cervical cord，nerve root，remove of tumor lesion thoroughly，reconstruct stabilization of the upper cervical spine and improve life quality of p
9、atients【Key words】Cervical vertebrae；Spinal canal；Neoplasms；Internal fixators上颈椎椎管内肿瘤一般指位于C1-3水平节段的肿瘤，可造成上颈髓及延髓受压，引起呼吸循环障碍，导致高位截瘫，甚至死亡。早期症状不明显，常表现为单纯枕颈部疼痛或不适、头颈歪斜、头颈部旋转活动受限，早期若无锥体束征等脊髓受压的表现，无明显的神经定位体征，易误诊或漏诊。目前，外科手术切除肿瘤病灶，解除对颈脊髓、神经根、椎动脉的压迫，内固定重建颈椎结构的稳定性，仍然是上颈椎肿瘤最有效、最主要的治疗方法。A tumor located at C1-3 c
10、alled canal tumors of the upper cervical spine. It may compress the upper cervical cord or the medulla oblongata which can cause respiratory and circulatory disorder, high paraplegia and even death. The early symptoms were not manifest, often simple occipital and neck pain or discomfort, neck tilted
11、, neck rotate limited. There was no neurological sign without spinal cord compression symptoms such as pyramid sign and often misdiagnosis or missed diagnosis. At present, surgical resection of the tumor lesion to relieved the compression of spinal cord, nerve root and vertebral artery, fixation sta
12、bility of cervical structure, reconstruct stabilization of the cervical spine with fixation is still the most effective and most important therapy of canal tumors of the upper cervical spine.资料与方法Material and methods一、一般资料1. Physical data 2003年1月至2008年6月，采用颈椎后路经椎板切除肿瘤、钉棒系统内固定及髂骨植骨融合治疗上颈椎椎管内肿瘤患者16例，男
13、10例，女6例；年龄33-68岁，平均44.7岁(表1)。硬膜外肿瘤2例(均为神经鞘瘤)，硬膜内髓外肿瘤13例(神经鞘瘤7例，脊膜瘤3例，脂肪瘤2例，神经纤维瘤1例)，髓内肿瘤1例(室管膜瘤)。肿瘤位于延髓C1 3例，C1，2 8例，C2水平2例，C1-3 2例，C2，3 l例；其中4例肿瘤位于颈髓腹侧。Between January 2003 and June 2008，16 patients(10 males and 6 females，average age 44.7 years, range 33-68 years) with canal tumor of the upper cerv
14、ical spine were treated by posterior laminectomy, fixation screw rod system and graft with autogenous iliac crest (table 1), including epidural neoplasms in 2 cases (Schwannoma)，intradural extramedullary tumors in 13 cases(Schwannoma in 7 cases, meningioma in 3 cases; lipoma in 2 cases; neurofibroma
15、 in 1 case)and intramedullary tumor in l case(ependymoma)The tumors were located between medulla oblongata and C1 in 3 eases，C1-2 in 8，C2 in 2，Cl-3 in 2，C2-3 in l；4 cases were located at ventralis of cervical cordTable 1 16 patients generally data and resultsCaseAge(y)GenderEtipathologyTumor locatedFollowing-up time(Mo)Frankel gradingJOA gradingimprovement ratePreo6 Mo postoPreo6 Mo posto146FSchwannomaC28DE81688.9239MSchwannomaC1,226DD81577.8368FSchwannomaC1-312DE717100.0446MSchwannomamedulla oblongata to C118CD71580.0533MSchwannomaC1,26DE1117100.0648FSchwannomaC1,258CD61581.8
