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目的探讨颈椎脊索瘤的临床特点及外科治疗方法与疗效。方法对1989年至2006年接受手术治疗的8例颈椎脊索瘤患者的临床资料进行回顾性分析。男5例,女3例;年龄34～72岁,平均53.8岁。依据肿瘤的WBB分期,实施次全或全椎体切除术3例,矢状切除术2例,次全或全脊椎切除术2例,颈椎管内脊索瘤囊外摘除术1例。脊柱稳定性重建术中,取自体髂骨植骨5例,钛网内骨水泥填塞前路椎体支撑2例。术后行辅助放疗。结果患者术后神经根性刺激症状较术前明显缓解或消失,颈髓压迫症状多有1～2个级别以上的改善。术后病理检查均可见典型“Physaliphorous细胞”。随访3～120个月,平均43.5个月。内固定物融合良好,植骨融合率100%。肿瘤局部复发4例,1例死于肿瘤复发后的高位截瘫并发症,全脊椎切除者未见复发迹象。7例未见远处转移,1例颈椎管内脊索瘤者既往有骶骨脊索瘤手术史,故考虑为原发骶骨脊索瘤继发硬膜下转移。结论颈椎脊索瘤临床相对少见,早期症状不典型,诊断应重视CT和MR检查。全脊椎切除术结合术后局部放疗可降低局部复发率。
Objective To investigate the clinical features and surgical treatment of cervical chordoma. Methods The clinical data of 8 patients with cervical chordoma admitted to our hospital from 1989 to 2006 were analyzed retrospectively. 5 males and 3 females; aged 34 to 72 years, mean 53.8 years old. According to the tumor’s WBB staging, 3 cases were performed subtotal or total vertectomy, 2 cases were treated by sagittal resection, 2 cases were treated by subtotal or total spondylectomy, and 1 case was treated by extracapsular cervical spinal chordoma. Spine stability reconstruction, autologous iliac bone graft in 5 cases, titanium mesh filled with cement in anterior vertebral body support in 2 cases. Adjuvant radiotherapy. Results The postoperative radicular irritation symptoms were significantly relieved or disappeared in patients with cervical spinal cord compression symptoms more than 1 or 2 levels of improvement. Postoperative pathological examination showed typical “Physaliphorous cells”. Follow-up 3 to 120 months, an average of 43.5 months. Internal fixation fusion, bone graft fusion rate of 100%. There were 4 cases of local tumor recurrence, 1 case died of complications of paraplegia after tumor recurrence, and no signs of recurrence were found in total splenectomy. 7 cases no distant metastasis, 1 cases of spinal canal chordoma who had previous history of sacral chordoma surgery, it is considered as the primary sacral chordoma secondary to subdural metastasis. Conclusion Cervical vertebral chordoma is relatively rare clinical, atypical early symptoms, diagnosis should pay attention to CT and MR examination. Total spondylotomy combined with postoperative local radiotherapy can reduce the local recurrence rate.