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目的探讨颈椎原发性骨肿瘤的临床特点、外科分期、不同手术入路与术式的治疗效果。方法脊柱肿瘤的外科分期为4期。共观察45例病例,Ⅰ期10例,Ⅱ期11例,Ⅲ期9例,Ⅳ期15例。11例行囊内切除,18例包膜切除,15例广泛切除,1例仅单纯行后路固定。结果术后随访6个月~10年,平均3年,1例上颈椎肿瘤术后高位瘫痪,因呼吸衰竭死亡。余44例术后近期疗效均较满意,局部疼痛和神经症状改善或缓解,2例眩晕患者术后症状消失;1例恶性神经鞘瘤和1例软骨肉瘤患者分别于术后13、24个月发生全身多处转移而衰竭死亡;1例骨母细胞瘤、1例软骨肉瘤、1例骨巨细胞瘤术后1年局部复发。结论应根据颈椎肿瘤的部位、外科分期选择相应的手术入路和术式。肿瘤的性质、手术方式及术后综合治疗对患者的预后具有重要影响。
Objective To investigate the clinical characteristics, surgical staging, different surgical approaches and surgical treatment of cervical primary bone tumors. Methods The surgical stage of spinal tumors is 4 stages. A total of 45 cases were observed, 10 in stage I, 11 in stage II, 9 in stage III, and 15 in stage IV. Eleven cases underwent intracapsular resection, 18 cases underwent resection, 15 cases underwent extensive resection, and one case was only posteriorly fixed. Results The patients were followed up for 6 months to 10 years, with an average of 3 years. One patient suffered from postoperative high cervical spondylosis and died of respiratory failure. In the remaining 44 cases, the short-term curative effect was satisfactory, and local pain and neurological symptoms improved or relieved. The symptoms of 2 cases of vertigo patients disappeared after surgery; 1 case of malignant schwannoma and 1 case of chondrosarcoma were treated at postoperative 13 and 24 months, respectively. Multiple metastases occurred in the body and died of failure; 1 case of osteoblastoma, 1 case of chondrosarcoma, and 1 case of giant cell tumor of bone recurred locally after 1 year. Conclusions According to the location of the cervical tumor and the surgical stage, the corresponding surgical approach and surgical procedure should be selected. The nature of the tumor, the surgical approach, and postoperative comprehensive treatment have important implications for the prognosis of the patient.