摘要
目的探讨颈后入路手术治疗寰枢椎硬膜下髓外神经鞘膜肿瘤的方法及疗效。方法 2012年1月-2017年3月,收治9例寰枢椎硬膜下髓外神经鞘膜肿瘤患者。其中男7例,女2例;年龄25~62岁,平均45.4岁。神经鞘瘤8例,神经纤维瘤1例;肿瘤位于C1 1例、C1、2 8例。病程5~120个月,平均45.9个月。术前美国脊髓损伤协会(ASIA)分级为D级8例,E级1例;日本骨科协会(JOA)评分为(12.8±2.5)分。所有患者均接受颈后入路手术治疗,肿瘤切除后其中2例行椎板回植内固定;均未行寰枢或枕颈固定。结果手术时间90~343 min,平均179.2 min;术中失血量50~1 000 mL,平均335.6 mL。术中及术后无手术相关并发症发生。患者均获随访,随访时间6~21个月,平均11.1个月。术后X线片复查示寰枢椎稳定性良好;肿瘤均切除彻底、未见复发;椎板回植内固定融合效果满意。术前3例ASIA分级为D级患者,术后3个月时改善为E级;其余患者分级无变化。术后6个月JOA评分为(15.1±1.4)分,较术前显著改善(t=4.221,P=0.003)。结论颈后入路手术可完全切除寰枢椎硬膜下髓外神经鞘膜肿瘤(包括腹侧肿瘤),必要时枢椎椎板可回植并采用微型钛板或椎板螺钉固定,无需行寰枢或枕颈内固定。
Objective To investigate the procedure and effectiveness of posterior approach for operation of atlantoaxial subdural extramedullary nerve sheath tumors. Methods Between January 2012 and March 2017, 9 patients with atlantoaxial subdural extramedullary nerve sheath tumors were treated, including 7 males and 2 females, aged 25-62 years(mean, 45.4 years). There were 8 cases of neurinoma and 1 case of neurofibroma. The tumors were located at C1 in1 case and C1, 2 in 8 cases. The disease duration ranged from 5 to 120 months, with an average of 45.9 months. The neural function was rated as grade D in 8 cases and grade E in 1 case according to the American Spinal Injury Association(ASIA)grading system. The Japanese Orthopaedic Association(JOA) score was 12.8±2.5. All patients underwent posterior cervical surgery. The laminae were replanted and fixed in 2 cases. The atlantoaxial or occipitocervical axis was not fixed in all patients. Results The operation time was 90-343 minutes, with an average of 179.2 minutes. The intraoperative blood loss was 50-1 000 mL, with an average of 335.6 mL. No relevant complication occurred after operation. All patients were followed up 6-21 months(mean, 11.1 months). The postoperative X-ray films showed the good stability of the cervical spine. All patients had complete tumor resection and no recurrence. The replanted laminae achieved fusion and the internal fixation was firm. According to ASIA grading system, 3 patients of preoperative ASIA grade D had upgraded to grade E at 3 months after operation, while the remaining patients had no change in grading. The JOA score was15.1±1.4 at 6 months after operation, which was significantly improved when compared with that before operation(t=4.221, P=0.003). Conclusion The atlantoaxial subdural extramedullary nerve sheath tumor(including the ventral tumor) can be removed completely via posterior approach. The axis lamina can be replanted and fixed with the small titanium plate or lamina screw when necessary, and the atlantoaxial or occipitocervi
作者
张宇
李柯柯
艾福志
夏虹
吴增晖
马向阳
ZHANG Yu;LI Keke;AI Fuzhi;XIA Hong;WU Zenghui;MA Xiangyang(Department of Spinal Surgery,General Hospital of Southern Theatre Command of Chinese PLA,Guangzhou Guangdong,510010,P.R.China;Department of Spinal Surgery,Huaxin Orthopaedic Hospital,Guangzhou Guangdong,510100,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第12期1480-1485,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
军队“十二五”重点项目（BWS11C065）
广州市科技计划项目（201607010183)~~
关键词
寰枢椎
神经鞘瘤
神经纤维瘤
颈后入路
Atlantoaxial vertebrae
neurinoma
neurofibroma
posterior approach
