显微手术结合脊柱内固定技术治疗椎管内外沟通性肿瘤（附129例报告）  

Microsurgical resection and spine instrumentation for treatment of intra - and extra - spinal tumors （ report of 129 cases ）

作　　者：范涛[1] 赵新岗[1] 孙鹏[1] 尚国松[1] 王向辉[1] 侯哲[1] 邱军[1] 

机构地区：[1]北京三博脑科医院(首都医科大学第十一临床医学院)神经外科,100093

出　　处：《中华神经外科杂志》2013年第9期871-875,共5页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科建设资助项目（SG2011-07-2）

摘　　要：目的探讨既能手术全切椎管内外沟通性肿瘤，又能维护和保证术后脊柱稳定性的最佳手术治疗策略。方法回顾性分析2008年8月至2012年12月作者采用显微手术结合术中脊髓神经电生理监测和脊柱内固定技术治疗的129例椎管内外沟通性肿瘤患者的临床资料。其中，硬膜外椎间孔内外沟通型49例，硬膜下椎间孔内外沟通型68例，椎旁巨大型12例。术中采用脊髓肌电或脊髓体感诱发电位监测相应节段脊髓和脊神经功能。对肿瘤侵犯椎体、椎弓根或椎问关节严重影响到脊柱稳定性时，在切除肿瘤的同时，行相应节段椎体重建和（或）椎弓根固定融合手术。结果手术全切123例，近全切除6例；切除肿瘤后同时行脊柱内固定手术47例，其中3例行颈前路椎体重建及固定融合术，44例行经椎弓根后路脊柱内固定术。术后病理：神经鞘瘤99例，神经纤维瘤8例，脊膜瘤9例，节细胞神经瘤5例，畸胎瘤1例，其他恶性肿瘤7例。术后2周原术前神经功能改善122例，症状同术前6例，加重1例。无手术感染、瘫痪及死亡病例。术后随访4—40个月，平均15个月；其中122例良性肿瘤患者均恢复正常工作生活，无加重及复发病例。7例恶性肿瘤患者中，3例死亡。结论全切除椎管内外沟通性肿瘤的同时，行相应的椎体重建和脊柱内固定手术，是治疗此类肿瘤、维护脊柱稳定性并巩固手术治疗效果的关键。Objective To discuss the most effective way to totally resect the tumor and protect the spinal stability through instrumentation. Methods The author retrospectivelly analysis 129 cases of intra - and extra- spinal tumors resected by microsurgery combined with intra- operative neurophysilogical monitoring and spinal instrumentation from Agust 2008 to December 2012. All intra - and extra - spinal tumors were divided into three types ： Type I ： extra - dural and intra - extra spinal tumor 49 cases ; Type 1] ： intra - dural and intra - extra spinal tumor 68 cases ; Type ]I ： paravertibral large tumor 12 cases. Spinal instrumentations, such as back route fixation or vertebral reconstruction, were used at one stage to maintain the spine＇s stability in selected cases. Results Tumors were totally removed in 123 cases （95.3%）, subtotally removed in 6 cases （4. 7% ）. Spine instrumentation was applied in 47cases, among which 3 was vertebral construction and 44 was back route fixation. Pathological analysis： neurinoma 99 cases, neurofibroma 8 cases, meningioma 9 cases, ganglioneuroma 5 cases, teratoid tumor 1 case, and other melignant tumors 7 caseses. The neurological function were improved in 122 cases 2 weeks after surgery, unchanged in 6 cases, worsen in 1 case. Follow- up range： 4 -40 monthes, average 15 monthes; No recurrent or wosen case was found in 122 patients with benign tumor. Among 7 malignant tumor patients, 3 died. Conclusions It is important to totally remove such intra- extra spinal tumors and use spine instrumentation to preserve the spine stability. Microsurgical technique combined with intra- operative SCEPs can benefit the total resection of the tumor and the maintainance of the neurological function. According to the location and instinct of the tumor, if the spine alignment was destroyed by the tumor or the resection, the spine instrumentation should be applied to maintain the spine stability.

关 键 词：椎管内外沟通性肿瘤 显微外科手术 脊柱内固定 

分 类 号：R739.4[医药卫生—肿瘤]