摘要目的探讨上胸椎肿瘤前路不同手术路径，肿瘤切除术式，Orion钢板或TSRH内固定术的作用。方法上胸椎肿瘤患者15例，其中骨巨细胞瘤5例，软骨肉瘤1例，嗜酸性肉芽肿1例，血管瘤1例，骨髓瘤1例，恶性淋巴瘤1例，转移癌4例；脊柱外科分期：Ⅰ期7例，Ⅱ期3例，Ⅲ期1例，Ⅳ期4例；肿瘤切除方式：囊内切除4例，包膜切除7例，广泛切除4例。根据肿瘤的病理类型，术后给予相应的放疗或化疗。结果术后随访3～20个月，2例术后出现声音嘶哑，系术中喉返神经牵拉伤所致，2个月后症状缓解。近期疗效均较满意，15例患者术后神经功能均有所改善。1例T1转移性腺癌（来源于化学感受器腺癌）患者术后16个月因全身多处转移，全身衰竭死亡。1例T1～T2骨巨细胞瘤患者囊内切除术后8个月局部复发。结论应根据肿瘤的部位、性质、分期选择相应的手术途径及肿瘤切除方式；前路植骨、人工椎体、Orion或TSRH内固定术有利于上胸椎的重建和稳定。

abstractsObjective　To investigate the effects of different anterior surgical approachs of upper thoracic spine, tumor excision procedure, Orion plate or TSRH fixation.　Methods　Oncologic types, surgical staging, clinical manifestation of tumors,different operative approaches, surgical procedures and prognosis were described. In 15 patients, 5 patients had giant cell tumor, 1 chondrosarcoma, 1 angioma, 1 eosinophilic granuloma,1 non-hodykin lymphoma, 1 solitary plasmacytoma, and 4 metastases. The tumors were divided into four stages: Ⅰ stage (7 patients), Ⅱ stage (3), Ⅲ stage (1), Ⅳ stage (4). Four patients underwent intracapsule excision, 7 marginal excision, and 4 wide excision. Radiotherapy and chemical therapy were given accordingly.　Results　Follow up for 3-20 months showed transient voice hoarse due to larygeal nerve injury in 2 patients. The symptoms of the injury disappeared in 2 months after operation. The neurological function after spinal cord in the 15 patients were improved. One patient with T1 metastatic gland cancer originated from the chemical susceptor died from general metastasis and failure 16 months after operation. One patient with giant cell tumor recurred 8 months after intracapsule excision.　Conclusions　Relative operative approach and procedures should be selected according to the nature, location and staging of tumors. Anterior bone graft, artificial vertebrae replacement,Orion plate or TSRH fixation are useful for reconstruction and stabilization of upper thoracic vertebrae.