CAJ | 학술논문

目的探讨完全切除合并内固定重建治疗合并斜颈的颈椎骨母细胞瘤的临床效果。方法回顾性分析2001年2月至2007年11月，我科收治的合并斜颈的颈椎骨母细胞瘤11例，年龄9～33(平均20.6)岁，其中男9例，女2例；C21例、C31例、C42例、C52例、C63例、C72例。所有病例均有斜颈改变，同时伴有颈部疼痛，Cobb’s角为20°～39°(平均27°)。按照ASIA分级标准，术前A级2例、B级3例、C级3例、D级2例、E级1例。其中后路7例，前后路联合椎体整体切除En-bloc4例，所有病例均行内固定重建。术前栓塞1例，术后放疗2例。结果所有病例均完整切除肿瘤瘤巢、肿瘤硬化骨、周围受累及的肿胀软组织和反应区。术后经病理证实均为骨母细胞瘤，其中2例为侵袭性骨母细胞瘤。所有病例均获60～126个月的随访，平均85.6个月，术后均无复发。术后5年颈部疼痛症状明显缓解，平均Cobb’s角较术前减少17°，差异有统计学意义(t＝9.220，P＜0.001)。术后ASIA分级较术前有所改善，术后平均提高1.82级(t＝5.590，P＜0.001)。术后患者无伤口感染及愈合不良，无神经症状加重等。术后发热2例、脑脊液漏1例，行延长置管时间后恢复。颈部酸胀麻木1例，给予理疗后好转。1例术后3年螺钉松动行内固定取出，给予支具佩带1年，随访时未出现明显颈椎后凸畸形和颈椎失稳。结论合并斜颈的青少年颈椎骨母细胞瘤早期行完全切除和内固定重建能改善颈部畸形、缓解疼痛、改善神经功能，提高患者生活质量。
목적탐토완전절제합병내고정중건치료합병사경적경추골모세포류적림상효과。방법회고성분석2001년2월지2007년11월，아과수치적합병사경적경추골모세포류11례，년령9～33(평균20.6)세，기중남9례，녀2례；C21례、C31례、C42례、C52례、C63례、C72례。소유병례균유사경개변，동시반유경부동통，Cobb’s각위20°～39°(평균27°)。안조ASIA분급표준，술전A급2례、B급3례、C급3례、D급2례、E급1례。기중후로7례，전후로연합추체정체절제En-bloc4례，소유병례균행내고정중건。술전전새1례，술후방료2례。결과소유병례균완정절제종류류소、종류경화골、주위수루급적종창연조직화반응구。술후경병리증실균위골모세포류，기중2례위침습성골모세포류。소유병례균획60～126개월적수방，평균85.6개월，술후균무복발。술후5년경부동통증상명현완해，평균Cobb’s각교술전감소17°，차이유통계학의의(t＝9.220，P＜0.001)。술후ASIA분급교술전유소개선，술후평균제고1.82급(t＝5.590，P＜0.001)。술후환자무상구감염급유합불량，무신경증상가중등。술후발열2례、뇌척액루1례，행연장치관시간후회복。경부산창마목1례，급여리료후호전。1례술후3년라정송동행내고정취출，급여지구패대1년，수방시미출현명현경추후철기형화경추실은。결론합병사경적청소년경추골모세포류조기행완전절제화내고정중건능개선경부기형、완해동통、개선신경공능，제고환자생활질량。
Objective To explore the clinical results of complete resection, internal fixation and reconstruction for osteoblastoma of the cervical spine combined with torticollis. Methods The clinical data of 11 patients with osteoblastoma of the cervical spine combined with torticollis who were adopted from February 2001 to November 2007 were retrospectively analyzed. There were 9 males and 2 females, whose average age was 20.6 years old ( range;9-33 years ). The cervical segments were involved, including C2 in 1 case, C3 in 1 case, C4 in 2 cases, C5 in 2 cases, C6 in 3 cases and C7 in 2 cases. All patients had both torticollis and cervical pain. The Cobb’s angle ranged from 20° to 39°, and the mean angle was 27.0°. Based on the American Spinal Injury Association ( ASIA ) impairment scale, there were 2 cases of grade A, 3 cases of grade B, 3 cases of grade C, 2 cases of grade D and 1 case of grade E before the operation. Resection through the posterior approach was performed on 7 patients and en-bloc resection through combined anterior-posterior approach was performed on 4 patients. All the patients underwent internal fixation and reconstruction. 1 patient embolization underwent preoperatively, and 2 patients radiotherapy underwent postoperatively. Results Tumor nests, sclerotic bone, peripheral tissues involved, swollen soft tissues and reaction zones were completely resected in all the patients. After the operation osteoblastoma was verified by pathology, including 2 cases of invasive osteoblastoma. The mean follow-up period was 85.6 months ( range; 60-126 months ). No recurrence was noticed after the operation. Cervical pain was obviously relieved at 5 years after the operation. The mean postoperative Cobb’s angle was 10.0° ( range;5°-15° ), which was decreased by 17o when compared with the preoperative angle. The differences between them were statistically signiifcant ( t=9.220, P<0.001 ).The postoperative ASIA impairment scale was increased by 1.82 grades on average ( t=5.590, P<0.001 ) when compared with the postoperative scale. No wound infection, poor healing or worse neurological symptoms occurred to the patients after the operation. Fever was noticed in 2 patients and cerebrospinal lfuid leakage in 1 patient, who all recovered after the indwelling time was prolonged. One patient had neck soreness and numbness, who got better after receiving physiotherapy. The screw loosening occurred to 1 patient at 3 year after the operation, who had the internal ifxator removed and then began to wear a brace for 1 year. During the follow-up, no serious cervical kyphosis or instability was found. Conclusions Complete resection, internal ifxation and reconstruction for osteoblastoma of the cervical spine combined with torticollis in adolescents can correct deformities of the cervical spine, relieve cervical pain, enhance the neurological function and improve the life quality of the patients.