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目的探讨颈段椎管内外“哑铃”形肿瘤的临床特点及手术方法。方法回顾分析11例经手术治疗的颈段椎管内外“哑铃”形肿瘤患者临床资料,男性7例,女性4例。经颈椎后路行肿瘤显微切除者9例,其中行半椎板切除4例(包括1例颈胸交界区Ⅲ期肿瘤和1例Ⅳ期肿瘤,均行颈椎后路钉棒系统内固定术),全椎板切开肿瘤切除后微钛片、钛钉椎板复位2例,经椎板间入路切除3例;其余2例经颈椎后路半椎板切除联合前外侧入路手术切除肿瘤。结果所有患者均经Ⅰ期显微手术全切除肿瘤(神经鞘瘤10例、节细胞神经瘤1例)。术后除1例感觉麻木面积略增大外,其余患者临床症状与体征明显改善,神经根性疼痛明显减轻或完全消失,肢体运动障碍改善。术后平均随访21个月,无一例肿瘤残留或复发,亦无脊柱畸形。结论颈段椎管内外“哑铃”形肿瘤术前可根据肿瘤外科分期和部位制定详细的手术方案,通过Ⅰ期显微手术切除。以半椎板入路为主,必要时可采取颈椎前后联合入路手术,影响颈椎稳定性者需同时行辅助内固定。
Objective To investigate the clinical features and surgical methods of cervical and dumbbell tumors. Methods Retrospective analysis of 11 cases of surgical treatment of cervical canal internal and external “dumbbell” tumor patients clinical data, 7 males and 4 females. Nine patients underwent microsurgical resection of the posterior cervical spine, including 4 cases of half-laminectomy (including 1 case of neck-thoracic junction Ⅲ tumor and 1 case of Ⅳ tumor. All patients underwent cervical spine rod internal fixation ). All the patients underwent resection of the tumor with micro-titanium plate and titanium nail in 2 cases, and 3 cases were removed by interlaminar approach. The other 2 cases were treated by anterior anterior approach Tumor. Results All patients undergone stage Ⅰ microsurgical resection of the tumor (Schwannoma in 10 cases, ganglioneuroma in 1 case). In addition to a case of sensory numbness increased slightly after surgery, the remaining patients with clinical symptoms and signs improved significantly, radicular nerve root pain was significantly reduced or completely disappeared, limb dyskinesia improved. After an average follow-up of 21 months, no tumor residual or recurrence, no spinal deformity. Conclusion Cervical spinal canal internal and external “dumbbell ” shaped tumor preoperative tumor surgery staging and site to develop a detailed surgical plan, by stage I microsurgical resection. Mainly to the half-lamina approach, if necessary, can be taken before and after cervical spine surgery, cervical stability affected by the need for simultaneous internal fixation.