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目的评价Ⅰ期一侧后入路保留椎板切除C_(1/2)神经鞘膜瘤的解剖学特点及疗效。方法2009年1月至2014年1月对符合以下手术指征患者行Ⅰ期单侧后入路保留椎板切除C_(1/2)神经鞘膜瘤:(1)硬膜外占位;(2)经C_(1/2)椎板间隙偏一侧向外生长;(3)具备神经鞘膜瘤影像学特征。共收治该类患者9例(男5例,女4例,平均年龄47.2岁,25至74岁)。收集颈椎JOA评分、术后轴性痛发生率、影像学特点、手术时间、出血量、并发症、末次随访颈椎侧位片寰齿前间隙等临床资料,经随访后予以分析总结。结果9例病例均得以随访,随访时间6至48个月,平均20个月。未出现复发病例,未出现颈椎失稳以及术后轴性疼痛病例,末次随访寰齿前间隙均小于2 mm。有神经功能损害的8例患者术前JOA评分(11.3±1.64),末次随访JOA评分(15.4±0.70),差异有统计学意义(P<0.05)。结论术前通过MRI判断上颈椎肿瘤类型,对符合手术指征的患者行Ⅰ期单侧后入路保留椎板切除上颈椎神经鞘膜瘤,术后疗效确切,可避免术后轴性痛,预后良好。
Objective To evaluate the anatomical characteristics and efficacy of laminectomy C_ (1/2) neoplasm medulloblastoma after Ⅰ-side posterior approach. Methods From January 2009 to January 2014, patients with the following surgical indications underwent unilateral posterior approach to laminectomy for C_ (1/2) nerve sheath tumor: (1) epidural; ( 2) out of one side of C_ (1/2) laminectomy; (3) with imaging features of neurovascular. A total of 9 cases of these patients were treated (5 males and 4 females, mean age 47.2 years, 25 to 74 years old). The clinical data of cervical JOA score, incidence of postoperative axial pain, imaging features, operation time, bleeding volume, complications and anterior cervical anterior odontoid anterior gap were collected and analyzed. Results All 9 cases were followed up for 6 to 48 months with an average of 20 months. No recurrent cases, no instability of cervical spine and postoperative axial pain were found. The anterior clearance of atlas was less than 2 mm at the last follow-up. The preoperative JOA score (11.3 ± 1.64) and the last follow-up JOA score (15.4 ± 0.70) in 8 patients with neurological impairment, the difference was statistically significant (P <0.05). Conclusions The type of upper cervical tumor was preoperatively evaluated by MRI. The patients who underwent surgical indications underwent unilateral posterior approach to retain the laminotomy on the cervical spondylotic nerve sheath tumor. The postoperative curative effect was definite and the postoperative axial pain, The prognosis is good.