CAJ | 학술논문

目的：总结上颈椎原发肿瘤全脊椎切除术的术中和术后并发症。方法：2005年3月~2013年7月采用分块全脊椎切除术治疗上颈椎原发肿瘤23例，其中男12例，女11例，年龄17~70岁，平均39岁。病变节段：C211例，C1、C22例，C2、C310例。21例患者术前诊断与术后病理诊断相符，其中脊索瘤10例，软骨肉瘤2例，骨巨细胞瘤7例，恶性周围神经鞘瘤1例，骨母细胞瘤1例。2例患者术前诊断与术后病理诊断不符，其中1例术前穿刺活检提示为骨母细胞瘤，术后病理确诊为纤维异常增殖症；1例术前病理检查提示为骨巨细胞瘤，术后病理诊断为低度恶性梭形细胞肿瘤。均行分块全脊椎切除术，手术采用前后联合入路，前路分颌下、经口或劈下颌骨入路三种方式；后方重建方式为枕颈固定，前方为钛板和自体髂骨块、钛板和钛网或单独异形钛网固定。术后辅助Halo架外固定。19例患者于围手术期行放射治疗，其中术前放疗8例，术后放疗11例。统计术中与术后并发症。结果：8例患者出现术中并发症，包括一侧椎动脉损伤5例、脊髓损伤1例、硬膜撕裂2例、喉上神经损伤2例。12例患者发生术后并发症，其中钛网前移压迫气管引起气道梗阻死亡和口咽粘膜感染大出血死亡各1例，迟发性椎动脉破裂出血1例，深部伤口感染6例，咽后壁粘膜延迟愈合6例、不愈合2例，肺炎4例，上消化道出血1例；内固定失败3例，植骨吸收内固定松动5例，植骨融合于倾斜的位置3例。结论：上颈椎原发肿瘤全脊椎切除手术并发症的发生率较高，主要并发症为术中椎动脉损伤、术后咽后壁伤口感染及后期内固定移位等。
목적：총결상경추원발종류전척추절제술적술중화술후병발증。방법：2005년3월~2013년7월채용분괴전척추절제술치료상경추원발종류23례，기중남12례，녀11례，년령17~70세，평균39세。병변절단：C211례，C1、C22례，C2、C310례。21례환자술전진단여술후병리진단상부，기중척색류10례，연골육류2례，골거세포류7례，악성주위신경초류1례，골모세포류1례。2례환자술전진단여술후병리진단불부，기중1례술전천자활검제시위골모세포류，술후병리학진위섬유이상증식증；1례술전병리검사제시위골거세포류，술후병리진단위저도악성사형세포종류。균행분괴전척추절제술，수술채용전후연합입로，전로분합하、경구혹벽하합골입로삼충방식；후방중건방식위침경고정，전방위태판화자체가골괴、태판화태망혹단독이형태망고정。술후보조Halo가외고정。19례환자우위수술기행방사치료，기중술전방료8례，술후방료11례。통계술중여술후병발증。결과：8례환자출현술중병발증，포괄일측추동맥손상5례、척수손상1례、경막시렬2례、후상신경손상2례。12례환자발생술후병발증，기중태망전이압박기관인기기도경조사망화구인점막감염대출혈사망각1례，지발성추동맥파렬출혈1례，심부상구감염6례，인후벽점막연지유합6례、불유합2례，폐염4례，상소화도출혈1례；내고정실패3례，식골흡수내고정송동5례，식골융합우경사적위치3례。결론：상경추원발종류전척추절제수술병발증적발생솔교고，주요병발증위술중추동맥손상、술후인후벽상구감염급후기내고정이위등。
Objectives: To summarize the intra-and post-operative complications of the total spondylectomy of the upper cervical spine primarty tumor in order to make the surgery safer and improve the outcomes. Methods: 23 cases with upper cervical primary tumor underwent total intralesional spondylectomy from March 2005 to July 2013. 12 males and 11 females were included with a mean age of 39 year(17-70 years). The defects included C2 in 11 patients, C1 to C2 in 2 patients, and C2 to C3 in 10 patients. Preoperative and postoperative histology results were same in 21 patients, which included 10 chordomas, 2 chondrosarcomas, 7 giant cell tumors, 1 malignant nerve sheath tumor and 1 osteoblastoma. 2 patients showed different histology results before and after the surgery. Preoperative osteoblastoma under biopsy turned out to be fibrous dyspla-sia after operation in 1 patient. Preoperative giant cell tumor turned out to be low-grade malignant spindle cells tumor in the other patient. Combined anterior and posterior approaches were performed including anteri-or-posterior procedure in 11 cases and posterior-anterior procedure in 12 cases. 3 types of anterior approach-es including transmandibular approach in 3 patients, transoral approach in 11 patients and high retropharyn-geal approach in 9 patients were performed. Anterior reconstructions were also carried out in 3 different ways, including plate and iliac crest strut graft in 4 patients, plate and mesh cage in 4 patients, and Harms mesh cage alone in 15 patients. Posterior occipitocervical fixations were carried out in all patients. Halo-vest was all used routinely. Results: Intraoperative complications occurred in 8 patients, which included one side ver-tebral artery injuries in 5 patients, spinal cord injury in 1 patient, dura tear in 2 patients, and superior la-ryngeal nerve injury in 2 patient. Postoperative complications occurred in 12 patients, which included one death of respiratory failure due to mesh cage dislocation, one death of oral wound delayed bleeding, and ver-tebral artery injury in 1 patient, wound infection in 6 patients, non-healing or delayed-healing of oral mucosa in 8 patients, pneumonia in 4 patients, and upper gastrointestinal bleeding in 1 patient. Failure of fusion was found in 3 patients, bone graft absorbed and hardware loosening in 5 patients and malpositional fusion in 3 patients. Conclusions: Upper cervical spondylectomy is a demanding surgery with high rate of perioperative complications. The complications mainly included intraoperative vertebral artery injuries, instrument failure and pharyngeal infections.