棘突悬吊式颈椎管扩大成形术治疗颈椎管内肿瘤的初步报告  

EXPANSIVE LAMINOPLASTY WITH REATTACHMENT OF SPINOUS PROCESS AND EXTENSOR MUSCULATURE FOR TREATMENT OF TUMOR IN CERVICAL VERTEBRAL CHANNEL

作　　者：夏景君[1] 张志鹏[1] 闫景龙[1] 庄金鹏[1] 裴刘宝[1] 沈洪涛[1] 

机构地区：[1]哈尔滨医科大学附属第一医院骨科,哈尔滨150001

出　　处：《中国修复重建外科杂志》2007年第6期614-616,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的介绍棘突悬吊式颈椎管扩大成形肿瘤摘除术,评价其在治疗颈椎管内肿瘤中应用的效果。方法2003年7月~2006年6月,治疗26例颈椎管内肿瘤,其中男14例,女12例;年龄25~57岁,病程3~24个月。四肢肌力~级,四肢肌张力高,腱反射亢进,病理反射阳性,2例出现髌阵挛及踝阵挛。术前MRI检查示肿瘤大小1.5cm×0.8cm^2.8cm×2.0cm,位于C3-6节段,其中C3、4节段8例,C4、5节段9例,C5、6节段9例。术前摄颈椎动力位X线片,测量患者颈椎平均活动范围,前屈30~45°,平均39.3°;后伸32~45°,平均40.5°;左侧屈20~45°,平均25°;右侧屈30~45°,平均36.6°。术后观察症状体征的变化,摄动力位X线片,测量颈椎活动范围,其中15例患者复查MRI及CT。结果术后患者均获随访6~12个月,平均8个月。患者感觉、肌力、肌张力、反射均有不同程度恢复,无并发症及死亡发生,生活全部自理。术后10例出现颈部酸痛,功能锻炼后逐渐缓解。术后7周复查MRI及CT可见棘突与椎板间骨性愈合,未出现“关门”现象,后柱结构基本恢复。术后复查动力位X线片示无颈椎不稳、椎管狭窄,颈椎活动范围:前屈28~43°,平均37.9°;后伸32~44°,平均41°;左侧屈25~45°,平均23°;右侧屈35~45°,平均36.2°。结论棘突悬吊式颈椎管扩大成形术既可充分显露肿瘤,又可在悬吊固定后最大程度保留后柱结构,有效预防术后并发症的发生。Objective To introduce a new operative technique of the expansive laminoplasty with reattachment of the spinous process and the extensor musculature for treatment of a tumor in the cervical vertebral channel and evaluate the clinical outcome of the technique. Methods From July 2003 to June 2006, this technique was applied to 26 patients （14 males, 12 females; age, 25-57 years; illness course, 3 months-2 years） in our hospital. The four limbs had a muscle force of Ⅲ- Ⅳ degrees, and with a high muscular tension. The tendon reflex was sthenic and 2 patients had patellar clonus and ankle clonus. MRI was used to measure the tumor size （from 1.5 cm ×0.8 cm to 2.8 cru×2.0 cm, at the C3-6 levels） before and after operation. There were 8 cases at the C3、4 levels, 9 cases at the C4、5 levels, 9 cases at the C5、6 levles. Results The result of the follow-up （average, 8 months; range, 6-12 months） showed that all the patients achieved a recovery at different degrees, with no death or complication. Although 10 of the patients felt a pain in the neck, but the pain was relieved after the functional exercise ; the cervical active scope was changed a little with no cervical intervertrbal instability. The postoperative MRI and CT showed that the posterior column was maintained, and the ＂close-door＂ phenomenon did not happen. The degree of latitule of the cervical vertebra after operation was measured. The antecollis was 28-43°（37.9° on average）. The hyposokinesis was 32-44°（41° on average）, the left antecollis was 25-45°（23° on average）, and the right antecollis was 35-45°（36.2° on overage）. Conclusion The expansive laminoplasty with reattachment of the spinous process and the extensor musculature can provide enough operative space and reserve the normal posterior column of the cervical vertebra. The intervertebral stability can be obtained after conglutination between the spinous process and the vertebral lamina. 　

关 键 词：棘突悬吊式 颈椎肿瘤 椎管成形 

分 类 号：R739.41[医药卫生—肿瘤]