摘要
目的 探讨颈椎管哑铃型肿瘤的显微手术策略,以期制定个体化手术方案。方法与结果共纳入2017年3月至2022年3月在安徽医科大学第一附属医院行颈椎管哑铃型肿瘤切除的32例患者(C节段7例、C节段25例),术前McCormick脊髓功能分级Ⅰ级9例、Ⅱ级12例、Ⅲ级11例。术前根据Toyama分型、影像学特点(肿瘤位置、体积、累及范围、患侧椎间孔大小)以及术中脊柱稳定性保护措施制定个体化手术方案;分别选择后正中入路(26例)、经侧方胸锁乳突肌后缘入路(2例)、前后联合入路(2例)和颈前入路(2例),术前脊柱稳定性破坏或者因手术影响脊柱稳定性的19例患者于肿瘤切除同期行内固定术(经颈前入路次全切除椎体并植入钛笼1例、于后路经椎弓根和侧块行螺钉内固定术18例)。肿瘤全切除率为100%(32/32),术中平均出血量为210 ml。术后1周影像学检查均未见肿瘤残留,行内固定术者内固定装置位置良好;术后1个月McC ormick分级Ⅰ级20例、Ⅱ级10例、Ⅲ级2例,脊髓功能明显改善,无一例症状加重;术后28个月随访时无脑脊液漏、中枢神经系统感染等严重并发症,无一例发生颈椎后突畸形、钉棒松动或断裂,植骨融合和椎体形态良好。结论 椎间孔大小是制定颈椎管哑铃型肿瘤手术策略的重要考量因素之一;尤其是C节段哑铃型肿瘤术中处理方式有别于其他节段,故需详细了解病史、症状与体征并完善术前影像学检查,有助于制定周密的个体化手术方案。
Objective To discuss the strategy for cervical dumbbell-shaped tumors and develop a proposal for individualized therapy.Methods and Results Total 32 patients with cervical dumbbellshaped tumors were recruited from The First Affiliated Hospital of Anhui Medical University from March2017 to March 2022.All patients received surgical treatments,while the tumors located in Clevels among 7 patients and Clevels among 25 patients.Preoperative McCormick spinal cord function grade Ⅰin 9 cases,grade Ⅱ in 12 cases,grade Ⅲ in 11 cases.Individualized surgical strategies were set according to the results of Toyama typing,preoperative imaging examination and intraoperative spinal stability.Surgery through posterior approach was performed in 26 cases,2 patients underwent a lateral posterior sternocleidomastoid approach,2 patients underwent surgery through combined posterior-anterolateral approach,and 2 patients received anterior cervical approach.Ninteen out of 32 patients with preoperatively unstable spinal factors or changes in spinal stability resulting from surgery received one-stage internal fixation.One patient underwent anterior cervical corpectomy and fusion followed by titanium cage implantation,and 18 patients underwent posterior trans-pedicle and lateral mass screw fixation.The results showed a gross total resection for all patients and the success rate was 100%(32/32).The average intraoperative blood loss was about 210 ml.Imaging examinations were performed for all patients within a week after the surgery,the internal fixator were all in good position.One month after the surgery McCormick spinal cord function grade Ⅰ in 20 cases,grade Ⅱ in 10 cases,grade Ⅲ in 2 cases.All patients had varying degrees of improvement in symptoms,no cerebrospinal fluid leakage,no serious nervous system infection and other complications,no postoperative cervical kyphosis,and no loosening or breakage of the screws and rods were found in 28 months after surgery,the bone graft fusion and vertebral body shape were good.Conclusions
作者
张科
王先祥
张义泉
程宏伟
ZHANG Ke;WANG Xian-xiang;ZHANG Yi-quan;CHENG Hong-wei(Department of Neurosurgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,China)
出处
《中国现代神经疾病杂志》
CAS
北大核心
2022年第8期680-686,共7页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
脊椎肿瘤
颈椎
显微外科手术
内固定器
Spinal neoplasms
Cervical vertebrae
Microsurgery
Internal fixators
