颈椎椎管内肿瘤术后稳定性研究  

Postoperative change of spinal stability in patients with cervical spinal cord tumor

作　　者：谢京城[1] 王振宇[1] 马长城[1] 李振东[1] 刘彬[1] 陈晓东[1] 

机构地区：[1]北京大学第三医院神经外科,100083

出　　处：《中华神经外科杂志》2008年第2期116-119,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨后路椎管内肿瘤切除术对颈椎稳定性的影响及相关因素。方法回顾性分析1992-2007年的82例颈椎管内肿瘤。对手术方式、手术前后的临床及医学影像进行复习，通过手术后随访评价患者脊柱生物力学的变化。结果82次后路手术按手术方式分为A组：后方经双侧椎板切除入路51例；B组：经半椎板切除入路31例。患者近期临床效果满意，两组间差异无统计学意义（P〉0．05）。随访3个月至14年，颈椎不稳定发生率A组12％、B组3％，A组高于B组（P〈0．05）。A组颈椎曲度恶化发生率为18％、B组为6％，B组小于A组（P〈0．05）。颈椎总活动度变化，A组手术后颈椎运动范围减小17％，B组手术后颈椎运动范围无改变（P〈0．05）。远期临床效果两组差异无统计学意义（P〉0．05）。结论对椎管内肿瘤，常规椎板切除及半椎板两种术式均可导致颈椎生物力学的变化。半椎板入路对颈椎生理曲度及运动度影响小，手术后不稳定发生率低。Objective To investigate the postoperative changes of spinal stability and relevant factors followed posterior approach removal of cervical spinal cord tumor, Methods The authors retrospectively analyzed a series of 82 patients with intra-spinal tumors surgically treated from 1992 to 2007. The clinical and radiographic data were reviewed. The short and long-term follow-up was performed to evaluate the clinical outcome and biomechanical change of the spine, Results The posterior approach were divided as group A： conventional laminectomy in 51 patients; group B： bemilaminectomy in 31 patients. The short-term clinical outcome was satisfactory in the two groups （ P 〉 0.05 ）. The period of follow-up ranged from 3 months to 14 years. The incidence of cervical spinal instability during the follow-up period was 12% in group A, and 3% in group B, （P 〈0.05 ）. The incidence of worsen of cervical curvature was found to be 18% in group A, 6% in group B, （P〈0.05）. In terms of rang of motion of cervical spine, there were decreased approximately 17% in the group A, however, no change in group B（ P 〈 0.05）. During the follow-up, no significant different was found between the two groups in terms of long-term clinical outcome （P 〉 0.05 ）. Conclusions In the surgical treatment of intraspinal tumors, conventional laminectomy and hemilaminectomy both have the tendency of influencing the biomechanical stability of cervical spine. Compared with traditional extensive laminectomy, the hemilaminectomy pose less impact of cervical curvature, range of motion, and spinal stability.

关 键 词：脊髓肿瘤 椎板切除术 显微外科手术 脊柱稳定性 

分 类 号：R739.4[医药卫生—肿瘤]