摘要
目的 探讨颈椎硬膜内髓外肿瘤的手术方式及钛网椎管重建的效果.方法 2002年3月至2008年9月手术治疗颈椎硬膜内髓外肿瘤26例,男14例,女12例;年龄6～76岁,平均38岁.术前神经功能Frankle分级,B级3例,C级8例,D级11例,E级4例.16例行半椎板切除（半椎板组）,10例全椎板切除后行钛网椎管重建（全椎板组）.术后随访6个月～5年,平均26个月,记录术后神经恢复及植骨融合情况.确认植骨融合后（术后6个月）,对半椎板组和全椎板组病例手术前后的颈椎曲度指数、颈椎活动度进行评估.结果 术后神经功能恢复Frankle分级均有改善.术前Frankle分级B级3例,术后提高到C级;术前C级8例提高到D级;术前D级11例提高到术后E级10例、D级1例.全椎板组钛网表面植骨块与上、下椎板融合,术后脊柱稳定,未发生畸形.半椎板组术后颈椎曲度指数丢失2.2±2.3,全椎板组术后颈椎曲度指数丢失4.3±2.5,两组患者手术前后颈椎曲度变化的差异有统计学意义（t=2.05,P＜0.05）.半椎板组术后颈椎活动度丢失1.3°±1.2°,全椎板组患者术后颈椎活动度丢失9.2°±4.1°,两组差异有统计学意义（t=1.71,P＜0.05）.结论 颈椎硬膜内髓外肿瘤体积小位于椎管一侧,适宜选择半椎板切除.对于需要行全椎板切除的病例,内固定及钛网椎管重建加植骨,可以重建脊柱的稳定性.
Objective To investigate the different operative style for the intraspinal extramedullary neoplasms in the cervical vertebrae as well as evaluate the clinical effect of titanium net for spinal canal reconstruction and bone autograft after laminectomy. Methods Since March 2002 to September 2008, 26patents （14 men, 12 women） with the intraspinal extramedullary neoplasm in the cervical vertebrae. The average age was 38 years （range, 6-76 yr）. According to Frankel classification, there were 26 cases for grade B before operation, 8 cases for grade C, 11 for grade D, and 4 for grade E. All patients underwent hemilaminectomy （as group HL） or total laminectomy combined with spinal canal reconstruction with titanium net （as group TL）. Recovery of nerve function and bone fusion were recorded. Preoperative and postoperative cervical curvature index and ranges of neck motion were recorded and compared. Results Among the 3cases with incomplete paraplegia, neurological status ameliorated from Frankel grade B to C; 8 cases of Frankel grade C recovered to grade D; 11 cases of Frankel grade D improved to grade E in 10 cases and 1to grade D. Bone fusion was formed on the titanium net and spinal stability was well after operation. Loss of cervical curvature indices was 2.2±2.3 in group HL and 4.3±2.5 in group of TL, and the difference was of statistically significant （t=2.05,P〈0.05）. At the same time, loss of ranges of neck motion was 1.3°±1.2°ingroup of HL and 9.2°±4.1°in group TL, significant difference was also seen （t=1.71 ,P〈 0.05）. Conclusion Hemi-laminectomy approach to intradural lesions lends itself well to eccentric tumors with smaller size. For the cases of total laminectomy, it is necessary and reliable to reconstitute integrity of spinal canal with titanium net and bone autograft.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第8期754-757,共4页
Chinese Journal of Orthopaedics
关键词
颈椎
脊髓肿瘤
椎管
Cervical vertebrae
Spinal cord neoplasms
Spinal canal
