椎管内髓外神经鞘瘤手术方式的多中心临床回顾性研究  

Multi-center clinical study of intraspinal extramedullary Schwannoma effect treated with operation

作　　者：宗少晖[1] 肖增明[1] 韦波[2] 杨渊[3] 杨昆 李兵 李书振[6] 刘宏斌[7] 刘彦[8] 张冉[9] 熊春翔[3] 

机构地区：[1]广西医科大学第一附属医院脊柱骨病外科,南宁530021 [2]广西医科大学公共卫生学院,南宁530021 [3]广西医科大学研究生学院,南宁530021 [4]广西骨伤医院,南宁530021 [5]广西柳州工人医院,545005 [6]广西中医学院附属瑞康医院,南宁530021 [7]北京大学深圳医院神经外科,深圳518036 [8]北京大学深圳医院病案室,深圳518036 [9]广西柳州市人民医院,545006

出　　处：《中国矫形外科杂志》2011年第21期1784-1788,共5页Orthopedic Journal of China

基　　金：广西医科大学博士后科研基金资助项目(项目编号:308083)

摘　　要：[目的]探讨手术治疗椎管内髓外神经鞘瘤的手术疗效和治疗策略。[方法]回顾性分析2008年6月～2010年11月手术治疗并获得完整随访的84例椎管神经鞘瘤患者的临床资料。手术方式分为:A种,全椎板切除+肿瘤显微摘除术;B种,半椎板切除+肿瘤摘除术;C种,全椎板切除+肿瘤摘除+椎弓根螺钉内固定术;D种,全椎板切除+肿瘤摘除术。以肿瘤所在部位:颈段、胸段、腰骶段分别进行评价患者肿瘤全切除率,手术时间,术中出血量,手术并发症,住院天数,住院总费用,采用视觉模拟评分(VAS)、日本矫形外科协会(JOA)评分标准。[结果]颈段椎管内髓外神经鞘瘤的切除首选半椎板切除+肿瘤摘除术。腰骶段神经鞘瘤建议采用全椎板切除+肿瘤摘除+椎弓根螺钉内固定术。胸段神经鞘瘤患者适用于全椎板切除+肿瘤显微摘除术。[结论]进行椎管内髓外神经鞘瘤手术方式的选择时,应根据肿瘤所在部位的不同,采取不同的手术方式进行有效治疗。[Objective]To retrospectively review the operative effect of intraspinal extraramedullary Schwannoma and summarize the suitable treatment strategy. [Methods]The clinical follow-up data of 84 patients with intraspinal extramedullary Schwannoma were retrospectively reviewed from November 2010 to June 2008.Surgical procedures were divided into total laminectomy and microscopic tumor enucleation（A） and semi-laminectomy and tumor excision（B） and total laminectomy and tumor excision and pedicle of vertebral arch screw fixation（C） and total laminectomy and tumor excision（D）.Complete resection rate and operation time and blood loss and surgical complications and length of stay and hospital costs and visual analog scale（VAS） and Japan Orthopaedic Association（JOA） scoring criteria were applied after surgery. [Results]The best surgical approach of intraspinal extramedullary Schwannoma of cervical vertebra was semi-laminectomy and tumor excision.The best surgical approach of intraspinal extramedullary Schwannoma of lumbosacral was total laminectomy and tumor excision and screw fixation.The best surgical approach of intraspinal extramedullary Schwannoma of thoracic vertebra was total laminectomy and microscopic tumor enucleation. [Conclusion]Patients with intraspinal extramedullary Schwannoma should receive different surgical treatments based on different places of the tumor.

关 键 词：神经鞘瘤 椎管内肿瘤 JOA评分 手术治疗 

分 类 号：R739.4[医药卫生—肿瘤]