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椎管内外沟通性“哑铃”形肿瘤显微手术治疗策略
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Journal Article
椎管内外沟通性“哑铃”形肿瘤显微手术治疗策略
2013
Overview
目的分析椎管内外沟通性'哑铃'形肿瘤的临床特点和显微手术治疗策略。方法共39例患者,分别采取单纯后正中入路手术(33例)和前后路联合入路手术(6例),其中30例于肿瘤切除同期行脊柱内固定术(C3~7侧块螺钉植入、其余椎体节段行椎弓根螺钉植入)。结果所有患者均达肿瘤全切除,术后随访6个月至5年,平均18.67个月。术后疼痛明显改善29例,平均视觉模拟评分由术前的7.51±1.05降至术后24 h的3.17±1.17(P<0.05);术后新发或感觉障碍区域扩大者12例、无明显变化者3例,美国脊髓损伤协会感觉评分由术前的218.67±2.80降至术后24 h的213.33±2.16(P<0.05),术后6个月时改善至216.78±1.47(P<0.05);肢体运动功能改善18例,美国脊髓损伤协会运动评分由术前的92.33±1.63提高至术后6个月的95.05±1.41(P<0.05)。术后无一例肿瘤复发或继发脊柱畸形。结论大多数椎管内外沟通性'哑铃'形肿瘤均可通过显微手术Ⅰ期完全切除。术前因骨质破坏或术中充分显露肿瘤而行椎间孔切开者,需于术中同时行植骨融合内固定以维持脊柱稳定性。
Publisher
首都医科大学宣武医院神经外科,北京,100053%哈尔滨医科大学附属第四医院神经外科,150001
Subject
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