摘要
目的 ：探讨胸腰段神经鞘膜瘤的影像学特点和手术治疗效果。方法 ：自2005年6月至2012年12月,手术治疗胸腰椎管内神经鞘膜瘤17例,其中男11例,女6例;年龄46~67岁,平均53岁;病程3~5年,平均3.3年。胸段患者表现为胸背痛,逐渐出现下肢麻木无力或行走不稳;腰段表现为腰背痛,下肢放射痛或感觉麻木,以及间歇性跛行。术前VAS评分（疼痛视觉模拟标尺法）5~8分,平均6.12分。11例患者神经功能受损,Frankel C级4例,D级5例,E级2例。CT和MRI检查提示病变部位：胸段3例,胸腰段5例,腰段3例,腰骶段6例;硬膜外5例,髓外硬膜下12例。6例单纯行椎管减压、肿瘤切除术,11例行椎管减压、肿瘤切除及后路内固定植骨融合术。结果：术中未发生大血管或脊髓损伤,术后伤口均正常愈合。17例患者术后均获随访,时间12~60个月,平均32个月。胸背痛、腰背疼痛和下肢放射痛等显著改善,下肢麻木感明显缓解。末次随访VAS评分0~3分,平均1.5分。神经功能受损患者末次随访Frankel分级：D级5例,E级6例。结论：MRI是胸腰段神经鞘膜瘤有效的辅助诊断方法,影像学表现决定具体手术方法,手术目的是椎管有效减压、肿瘤彻底切除和脊柱稳定性的重建。
Objective：To explore the imaging characteristics and operation outcomes of intramedullary schwannoma in thoracolumbar spine. Methods：From June 2005 to December 2012,17 patients with intramedullary schwannoma in thoracolumbar spine were operated through posterior approach,including 11 males and 6 females with an average age of 53 years old ranging from 46 to 67 years old. The courses of disease ranged from 3 to 5 years（averaged 3.3 years）. Thoracic patients manifested chest and back pain,numbness and inability on lower limb gradually,unsteady gait. Lumbar patients manifested low back pain,radiating pain and numbness on lower limb,intermittent claudication. Preoperative VAS score was 5 to 8 with an average of 6.12. Eleven patients suffered from never injury,4 cases were grade C,5 cases were grade D and 2 cases were grade E according to Frankel classification. Three patients were injured on thoracic segments,5 patients were on thoracolumbar segments,3 patients on lumbar segments and 6 patients on lumbosacral segment confirmed by CT and MRI. Five patients were epidural,12 were intradural extramedullary. Six patients underwent spinal decompression and tumor resection simply,eleven patients underwent spinal decompression,tumor resection,internal fixation and bone graft fusion. Results：No injury of blood vessel or spinal cord occurred during operation,cutting healed well. All patients were followed up from 12 to 60 months with an average of 32 months. Chest and back pain,low back pain,radiating pain and numbness on lower limb were improved significantly. VAS score at final follow up was 0 to 3（averaged 1.5）. According to Frankel classification,5 cases were grade D,and 6cases were grade E at final follow up. Conclusion：MRI is an effective method in diagnosis of intramedullary schwannoma in thoracolumbar spine. Operative method is choosed by imaging expression,and the aim is effectively decompression of spine,reconstruction of stability of spine.
出处
《中国骨伤》
CAS
2015年第12期1117-1120,共4页
China Journal of Orthopaedics and Traumatology
关键词
胸椎
腰椎
放射摄影影像解释
计算机辅助
外科手术
Thoracic vertebrae
Lumbar vertebrae
Radiographic image interpretation
computer assisted
Surgical procedure
operative
