半椎板-小关节突切除术后颈椎稳定性的研究  

Postoperative change of spinal stability after hemi - laminectomy and facetectomy approach for resection of dumbbell shaped cervical spinal cord tumor

作　　者：谢京城[1] 王振宇[1] 马长城[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,100191

出　　处：《中华神经外科杂志》2011年第9期885-889,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨经半椎板-小关节突切除椎管内外哑铃形肿瘤后对颈椎稳定性的影响及相关因素。方法回顾性分析经后路患侧半椎板-小关节突切除入路治疗的25例颈椎哑铃形肿瘤患者（研究组）的资料。选取同期经半椎板椎管内肿瘤切除病例30例为对照组。对手术前后的临床及医学影像进行复习，评价患者疗效及脊柱生物力学的变化。结果本组25例哑铃形肿瘤、对照组30例椎管内肿瘤均获全切，患者近期疗效满意。随访7个月-10年，平均4．28年，颈椎总运动度两组均无变化；颈椎曲度恶化发生率研究组为8％，对照组为10％（P〉0．05）；颈椎不稳定性发生率研究组为4％，对照组为3％（P〉0．05）。远期疗效两组间差异无统计学意义（P〉0．05）。结论良性颈椎管内外哑铃形肿瘤经后路半椎板-小关节突入路切除，手术对颈椎运动度、生理曲度影响小，手术后不稳定发生率低。Objective To evaluate the postoperative changes of spinal stability and relevant factors followed posterior approach via hemilamineetomy and facetectomy for removal of dumbbell shaped cervical spinal cord tumor. Method The authors retrospectively analyzed a series of 25 patients with dumbbell intra -extra spinal tumors surgically treated through hemilamineetomy and faeeteetomy from 1999 to 2009. 30 patients with intra - spinal tumor removed through hemilamineetomy approach during the same period were chosen as comparative group. The clinical and radiographic data were reviewed. The short and long -term follow - up was performed to evaluate the clinical outcome and biomeehanical change of the spine. Results 25 operations had been performed with gross total of tumor resection in all cases with histological of neurolemomas in 19 eases, neurofibroma in 1 case, ganglioneuroma in 5 cases. As comparative group, 30 tumors which had been removed successfully including neurolemomas in 24, meningiomas in 6 cases were analyzed. The short - term clinical outcome was satisfactory in the two groups （ P 〉 0. 05 ）. The period of follow - up was ranged from 7 months to 10 years with average of 4. 28 years. There was no change in terms of range of motion of cervical spine in both groups. The incidence of worsen of cervical curvature was found to be 8% in research group, 10% in comparative group （ P 〉 0. 05 ） . The incidence of cervical spinal instability during the follow - up period was 4% in research group, and 3% in comparative group （ 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 Benign dumbbell shaped spinal cord tumor of cervical spine are well exposed and totally removed with satisfactory outcome via hemilamineetomy and facetectomy approach. Compared with hemilaminectomy, hemilaminectomy and facetectomy equally pose little impact of cervical curvature, range of motion, and spinal stabi

关 键 词：脊髓肿瘤 椎板切除术 显微外科手术 

分 类 号：R687.3[医药卫生—骨科学]