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目的 探讨侵犯椎体及其附件的高颈段哑铃型神经鞘膜瘤显微外科手术及颈椎后路植骨固定的方法与特点。方法 分析7例高颈段哑铃形椎管内肿瘤病人的临床特点、影像学特征、显微手术及颈椎后路植骨固定的方法与治疗结果等。结果 7例患者术前均经CT或MRI检查作出临床诊断,肿瘤位于颈1～2椎体平面2例,颈2～4椎体平面5例,均为哑铃形生长,沿椎间孔从椎管内延伸至椎管外,相邻颈椎椎体及其附件不同程度破坏、颈髓不同程度受压移位、椎动脉被肿瘤包绕2例,推挤移位5例,均行显微手术切除肿瘤并颈椎后路植骨固定术,全切5例,部分切除2例,治疗效果良好。结论 高颈段哑铃形椎管内肿瘤多伴不同程度颈椎及其附件破坏,脊柱稳定性受损,切除肿瘤后,绝大多数患者需行颈椎后路植骨固定,以防术后椎体不稳造成脊髓压迫。
Objective To investigate the methods and characteristics of microsurgical operation and posterior cervical spine bone graft fixation of high-necked dumbbell neurofibroma invaded the vertebral body and its attachments. Methods The clinical features, imaging features, microsurgical techniques and methods of posterior cervical spine bone fixation and treatment of 7 patients with high-dumbbell spinal canal tumors were analyzed. Results All the 7 patients were diagnosed by CT or MRI preoperatively. The tumors were located in 1 ~ 2 cervical vertebral body in 2 cases and in 2 ~ 4 cervical vertebral body in 5 cases. All of them were dumbbell shaped. Tubes extend to the outside of the spinal canal, the adjacent vertebral body and its attachment to varying degrees of damage, cervical spinal cord compression displacement of varying degrees, the vertebral artery was surrounded by tumor in 2 cases, 5 cases of push displacement, underwent microsurgery Excision of tumor and posterior cervical spine bone fixation, 5 cases of complete removal, partial resection in 2 cases, the treatment effect is good. Conclusions High-dumbbell-shaped spinal canal tumors in high-necked area are often damaged by cervical spine and its attachments to varying degrees and their spinal stability is impaired. After resection of the tumor, the vast majority of patients need to undergo cervical spine posterior bone graft to prevent postoperative vertebral body Stable into spinal cord compression.