摘要
目的总结显微手术切除椎管哑铃形肿瘤而尽量保护脊柱稳定性的方法。方法我科从2004年5月～2006年7月,采用显微手术切除椎管哑铃形肿瘤22例。其中颈段肿瘤16例,分别采用改良的极外侧入路、颈前入路、分次后正中和前路联合切除并行内固定加植骨融合,后正中入路全椎板切除加椎管成形或半椎板切除。胸段肿瘤2例采用半椎板切除,1例采用全椎板切除。3例腰段肿瘤采用半椎板切除,其中2例行钉棒固定。结果肿瘤全切除20例,次全切除2例。所有病例术后症状均明显改善。18例随访9～18个月,无复发或脊柱不稳定。结论大部分椎管哑铃形肿瘤可采用半椎板切除手术,极外侧入路适用于微创切除体积较大的高颈段肿瘤,对骨质破坏严重的肿瘤和完全切除一侧小关节者需行内固定手术。
Objective To summarize the experience in microsurgically resecting dumbbell-shaped tumors of the vertebral canal and preserving spinal stability. Methods Twenty-two patients with dumbbell-shaped tumors of the vertebral canal underwent microsurgical resection during May 2004 to July 2006. Sixteen cervical tumors were reseeted via modified far lateral approach （posterior lateral intermuscular approach）, anterior cervical approach and posterior midline approach combined with internal fixation and bone grafting and fusion. Total lamineotomy with laminoplasty or semi-laminectomy was performed via posterior midline approach. Thoracic tumor was resected by semi-laminectomy in 2 eases, by whole laminectomy in 1. All 3 lumbar tumors were reseeted by semi-lamineetomy, 2 of which were fixed by screw rods system after removing the tumor. Results Twenty tumors were totally removed, and the other 2 tumors were subtotally removed. In all the eases, the symptoms released obviously after operation. Eighteen patients were followed up for 9-18 months, and no tumor relapse or instability of the spine was found. Conclusion Most dumbbell-shaped tumors of the spinal canal can be removed by semi-lamineetomy, while far lateral approach is suitable for large tumors in the upper cervical segment. Internal fixation is necessary after the tumor was removed for the patients who had severe bony destruction due to the tumor and those whose small joints are completely removed.
出处
《中国微侵袭神经外科杂志》
CAS
2007年第2期66-68,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
椎管
肿瘤
显微外科手术
spinal canal
neoplasms
microsurgery
