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目的 :探讨一期后路手术切除Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤的可行性及短期临床疗效。方法:回顾性分析2006年1月~2016年1月收治的10例Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤患者,其中男8例,女2例,年龄40~65岁,平均56.2±7.8岁。神经鞘瘤8例,神经纤维瘤2例。肿瘤位于C1/25例,C2/3 3例,C3/4 2例。Toyama Ⅲb型7例,Ⅵ型3例。术前行MRI测量椎管外肿瘤距离硬膜囊边缘的最大径为4.0~6.5cm,平均4.8±0.7cm;JOA评分平均为9.5±3.5分;ASIA分级,B级1例,C级1例,D级2例,E级6例。均采用一期后路手术切除肿瘤及单侧内固定重建颈椎的稳定性,术后行JOA评分及ASIA残损分级评价神经功能改善情况,复查X线评估颈椎的稳定性。结果:所有的肿瘤均一期后路完全切除,其中椎管外瘤体均是完整的整块切除,无椎动脉损伤、神经功能障碍加重。手术时间为210~270min(231.0±18.5min),术中出血量为400~700ml(550.0±87.9ml),住院时间为6~8d(7.2±0.8d)。随访6~15个月,平均12.0±3.0个月,随访期间未见肿瘤复发者,患者的神经症状及阳性体征较术前明显改善。术后半年的平均JOA评分为15.4±1.4分,与术前比较差异有统计学意义(P<0.05);ASIA分级D级1例,E级9例,末次随访时D级1例也恢复到E级,末次随访与术前ASIA分级比较差异具有统计学意义(P<0.05)。10例患者随访期间无内固定松动和后凸畸形的发生。结论:Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤可经一期后路手术切除并恢复颈椎的稳定性,短期的临床疗效较满意。
Objective: To investigate the feasibility and short-term clinical efficacy of first stage posterior resection of dumbbell tumors of Toyama Ⅲb and Ⅵ upper and lower cervical spinal canal. Methods: Ten cases of Toyama Ⅲb and Ⅵ upper and lower dumbbell tumors of the upper and lower cervical spinal canal admitted from January 2006 to January 2016 were retrospectively analyzed. There were 8 males and 2 females, aged 40-65 years, with an average of 56.2 ± 7.8 years old. Schwannoma in 8 cases, 2 cases of neurofibroma. Tumors were located in C1 / 25 cases, C2 / 3 cases, C3 / 42 cases. Toyama Ⅲ b in 7 cases, Ⅵ in 3 cases. Preoperative MRI measurement of spinal canal tumor from the edge of the dural sac maximum diameter of 4.0 ~ 6.5cm, an average of 4.8 ± 0.7cm; JOA score average of 9.5 ± 3.5 points; ASIA grade, B grade in 1 case, C grade in 1 case , D grade in 2 cases, E grade in 6 cases. All patients underwent one-stage surgical resection of the tumor and unilateral internal fixation to reconstruct the stability of the cervical spine. Postoperative JOA score and ASIA lesion grade were used to evaluate the improvement of neurological function. X-ray was used to evaluate the stability of the cervical spine. Results: All the tumors were completely resected in the posterior phase of the anterior segment. All the tumors of the spinal canal were completely resected without vertebral artery injury and neurological dysfunction. The operation time ranged from 210 to 270min (231.0 ± 18.5min). The intraoperative blood loss was 400-700ml (550.0 ± 87.9ml) and the hospitalization time was 6-8 days (7.2 ± 0.8d). All the patients were followed up for 6-15 months with an average of 12.0 ± 3.0 months. No recurrence was found during the follow-up. The neurological symptoms and signs of the patients were significantly improved compared with that before the operation. The mean JOA score at six months after operation was 15.4 ± 1.4, which was significantly lower than that before operation (P <0.05). ASIA was classified as grade D in 1 case and grade E in 9 cases. At the final follow-up, grade D was also recovered to Grade E, the difference between the last follow-up and preoperative ASIA classification was statistically significant (P <0.05). Ten patients were followed up without internal fixation and kyphosis occurred. Conclusion: Toyama Ⅲb and Ⅵ type of upper and lower cervical spinal dumbbell tumors can be surgically removed after a period of operation and restore the stability of the cervical spine, short-term clinical efficacy is satisfactory.