摘要
目的探讨不同入路显微手术切除颈椎管哑铃形肿瘤的手术方法,总结其主要优点和术后并发症情况。方法2004年5月至2006年7月共收治16例颈椎管哑铃形肿瘤,其中5例肿瘤最大径超过5cm。5例巨大肿瘤中4例位于上颈段,采用侧方改良的极外侧入路（后外侧肌间入路）, 1例外院手术复发的巨大肿瘤位于中颈段,采用分次后正中和前路联合切除并行后方和前方内固定加前方植骨融合;1例肿瘤椎管外部分向前方生长,采用颈前入路切除后行前方植骨融合加内固定,其余10例采用后正中入路,其中1例超过中线的肿瘤采用全椎板切除加椎管成形,7例半椎板切除, 1例复发肿瘤原路切除,1例未切除椎板切除肿瘤。结果手术全切肿瘤14例,次全切2例。所有病例术后症状均有明显改善,其中2例巨大肿瘤患者术后出现低氧血症,重新气管插管后逐渐恢复, 1例巨大肿瘤患者术后脑脊液漏皮下积液,经穿刺置管引流数日后恢复正常。其中12例随访9-18个月,无一例复发或出现脊柱不稳定的情况。结论对于颈椎管哑铃形肿瘤,应尽可能采用创伤小的手术方式,在切除肿瘤的同时,减少棘突、韧带、椎板以及小关节的破坏,减小创伤和对脊柱稳定性的破坏,预防脊柱后凸和侧凸畸形的发生。极外侧入路适用于微创切除体积较大的高颈段椎管哑铃形肿瘤,较小的肿瘤可以采用后正中入路半椎板开窗手术,对骨质破坏严重者需在切除肿瘤后行内固定手术。
Objective To study the different approaches of microsurgical procedures for management of dumb bell tumors of the cervical vertebral canal, summarize the advantages as well as the postoperative complications. Methods From May 2004 to July 2006, Sixteen cases of cervical vertebral canal dumb bell tumors were treated in our department, five of which were huge tumors of over 5cm in maximum diameter. Four cases of the huge tumors located in the upper cervical segment were removed through modified far lateral approach（ posterior lateral inter muscular approach）, one recurrent huge tumor located in the middle cervical segment was removed by combined anterior and posterior operations with anterior fusion and both side internal fixation. In one case, the tumor protruded anteriorly out of the canal , was removed through anterior cervical approach combined with internal fusion and fixation. The other ten cases were removed through posterior midline approach, in which one tumor exceeding midline was removed by whole laminectomy with laminoplasty, seven cases by semi-laminectomy, one recurrent tumor was removed with previous approach, one case was removed even without laminectomy. Results Fourteen tumors were totally removed, the other two tumors were subtotally removed. In all cases, the symptoms released obviously after operation. Two cases of cervical huge tumors occurred hypexia postoperatively, which disappeared gradually after intubation. One young man with huge cervical tumor occurred CSF leakage and subcutaneous fluid accumulation after surgery, which was cured after catheter drainage. Twelve cases were followed up for 9 - 18 months, no recurrence or instability of the spine occurred. Conclusion For dumb bell tumors of the cervical canal, less invasive procedures should be tried whenever possible, in order to decrease the destruction of the spinal crests, the ligaments, spinal plates, and the small joints, thus preserve the stability of the spine and prevent kyphosis and scoliosis. Far lateral approach is suit fo
出处
《中华神经外科杂志》
CSCD
北大核心
2007年第5期325-328,共4页
Chinese Journal of Neurosurgery
关键词
椎管
颈
肿瘤
半椎板切除
极外侧入路
Spinal canal, neck
Neolasms
Semi-laminectomy
Far lateral approach
