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目的:探讨颈椎肿瘤单侧关节突关节切除后稳定性重建的方法及效果。方法:对1999～2005年在我院骨科手术治疗且得到随访的18例切除单侧关节突关节的颈椎肿瘤患者的资料进行分析,男10例,女8例;年龄16～72岁,平均46岁。神经根受压表现为主者10例,VAS评分2～8分,平均4.2分;脊髓压迫表现为主者8例,ASIA分级C级5例,D级3例。均采用颈后路患侧关节突关节、侧块切除,完整切除肿瘤组织,其中10例行单侧侧块钢板固定植骨融合,8例行双侧侧块钢板固定植骨融合。结果:随访3～60个月,平均20个月,1例透明细胞癌肺转移患者死亡,余存活无复发。10例神经根受压表现为主者术后疼痛VAS评分0～4分,平均1.6分。8例脊髓压迫表现为主者,5例术前C级者术后C级2例、E级3例,3例术前D级者术后D级2例、E级1例。双侧侧块钢板固定植骨融合者术后3个月4例出现骨性融合(其中1例3个月后失访),6个月7例达到骨性融合,内固定无断裂、松动、移位,无颈椎不稳。单侧侧块钢板固定植骨融合者,1例术后5个月出现颈部疼痛;9例在术后9个月骨性融合;1例12个月时仍未能骨性融合,螺钉松动。结论:颈后路侧块钢板固定植骨融合可以实现颈椎肿瘤单侧关节突关节切除后的颈椎稳定性重建。
Objective: To investigate the method and effect of stability reconstruction after excision of unilateral facet joint in cervical tumor. Methods: The data of 18 patients with cervical spondylotomy who underwent unilateral arthrodesis in our hospital from 1999 to 2005 were retrospectively analyzed. There were 10 males and 8 females, aged from 16 to 72 years, with an average of 46 year old. Nerve root compression manifested mainly in 10 cases, VAS score of 2 to 8 points, an average of 4.2 points; 8 cases of spinal cord compression was the main performance, ASIA grade C grade in 5 cases, D grade in 3 cases. All the patients were treated with posterior cervical ipsilateral metacarpophalangeal joint. The lateral mass was excised and the tumor tissue was completely excised. Ten patients underwent unilateral lateral plate fixation and fusion, while 8 patients underwent bilateral lateral mass plate fixation and fusion. Results: The patients were followed up for 3 to 60 months with an average of 20 months. One patient with clear cell carcinoma had lung metastasis and the remaining without recurrence. 10 cases of nerve root compression showed the main postoperative pain VAS score 0 to 4 points, an average of 1.6 points. Eight patients underwent spinal cord compression. Five patients underwent preoperative C grade postoperatively, 2 postoperative grade C, 3 postoperative grade E, 3 postoperative grade D postoperatively, 2 postoperative grade D and 1 postoperative grade E. Bilateral fusion of the lateral mass plate and bone fusion occurred in 4 cases 3 months after the operation, with bony fusion (1 case was lost after 3 months), 7 cases achieved bony fusion at 6 months, no fracture, loosening, Displacement, cervical instability. One patient had cervical pain at 5 months after operation with one-sided lateral plate fixation. Nine patients had osteosynthesis at 9 months after surgery. One patient had no bony fusion at 12 months and had loose screws . CONCLUSION: The posterior cervical posterior fixation with plate fixation and fusion can be used to reconstruct the cervical spine after unilateral resection of the cervical facet joint.