摘要
目的探讨全椎板入路切除椎管内巨大肿瘤（长径〉3cm）并重建椎管的疗效。方法2009年3月-2012年2月，对21例椎管内巨大肿瘤采用经全椎板入路切除并椎管重建治疗。男12例，女9例；年龄21～62岁，平均40．5岁。术前采用日本骨科协会（JOA）17分法对神经功能评分，0～5分4例，6～11分9例，12～17分8例。x线片测量示Cobb角均〈10°。MRI检查示，肿瘤位于颈段3例，颈胸段1例，胸段8例，胸腰段2例，腰段7例；矢状位肿瘤长径为3．0～16．5cm，平均8.3cm。肿瘤全切除17例，次全切除4例。结果病理检查示，神经鞘瘤9例，神经纤维瘤6例，脂肪瘤3例，脊膜瘤2例，支气管性囊肿1例。术后患者切口均I期愈合。21例均获随访，随访时间1～3年，平均2-3年。术后x线片示，3例脊柱侧弯Cobb角〉10°，内固定物无移位。末次随访时按JOA17分法评定，获0～5分1例，6～11分10例，12～17分10例，与术前比较差异有统计学意义（Z=-3．26，P=-0．02）。结论全椎板入路切除椎管内巨大肿瘤并重建椎管是一种安全、简便、易行的手术方式，能最大程度切除肿瘤，缓解临床症状，维持脊柱稳定性。
Objective To investigate the effectiveness of the posterior midline approach with complete laminectomy for giant intraspinal tumor （more than 3 cm in diameter） resection and vertebral canal reconstruction. Methods Between March 2009 and February 2012, 21 cases of giant intraspinal tumor underwent the posterior midline approach with complete laminectomy and vertebral canal reconstruction. There were 12 males and 9 females with an average age of 40.5 years （range, 21-62 years）. The Japanese Orthopaedic Association （JOA） scores were 0-5 in 4 cases, 6-11 in 9 cases, and 12-17 in 8 cases. The preoperative Cobb angle was less than 10° on the X-ray films. MRI showed that the tumor located at the cervical part in 3 cases, at the cervicothoracic part in 1 case, at the thoracic part in 8 cases, at the thoracolumbar part in 2 cases, and at the lumbar part in 7 cases; the long diameter of tumor on the sagittal view was 3.0-16.5 cm （mean, 8.3 cm）. Total resection of tumor was performed in 17 cases, and subtotal resection in 4 cases. Results Postoperative pathological examinations showed 9 cases of neurilemmoma, 6 cases of neurofibroma, 3 cases of lipoma, 2 cases of meningioma, and 1 case of bronchogenic cyst. Primary healing of incision was achieved in all patients. The patients were followed up 1-3 years （mean, 2.3 years）. Postoperative X-ray film showed that Cobb angle was more than 10° in 3 cases, and no displacement of internal fixator was observed. The JOA scores were 0-5 in 1 case, 6-11 in 10 cases, and 12-17 in 10 cases, showing significant difference when compared with preoperative scores （Z=3.26, P=0.02）. Conclusion The posterior midline approach with complete laminectomy for giant intraspinal tumor resection and vertebral canal reconstruction is a safe, simple, and feasible operation way, and it can resect tumor to a maximum extent, relievethe clinical symptoms, and maintain the spinal stability.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第6期733-736,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
全椎板入路
椎管内肿瘤
椎管重建
Posterior midline approach with complete laminectomy Intraspinal tumor Vertebral canalreconstruction
