脊柱内固定技术在切除多节段椎管内肿瘤中的应用(附12例报道)  

Application of intraspinal internal fixation to microneurosurgery for multilevel spinal tumors(report of 12 cases)

作　　者：田学丰[1] 冯春国[1] 王先祥[1] 程宏伟[1] 李志范[1] 张科[1] 

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《中国临床神经外科杂志》2016年第11期673-675,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脊柱内固定技术在切除多节段(3个或3个节段以上)椎管内肿瘤中的作用。方法回顾性分析2014年1月至2016年1月采用脊柱内固定技术结合显微神经外科手术治疗12例多节段椎管内肿瘤的临床资料。在显微镜下手术,应用体感诱发电位监测脊髓神经功能,在切除肿瘤的同时行椎弓根或侧块(颈段)钉棒内固定技术重建脊柱后柱。结果 5例室管膜瘤、2例脊膜瘤和2例硬膜外血管畸形均全切除,2例脂肪瘤大部切除,1例星形胶质细胞瘤部分切除;内固定时无神经、脊髓、血管损伤。术后无感染。9例术前有下肢肌力下降,术后2周明显好转;2例脂肪瘤术后出现下肢疼痛和麻木,但未出现肌力下降加重。术后X线检查示,内固定置入物基本符合要求。术后随访无固定装置断裂、移位病例。结论脊柱内固定联合显微神经外科技术是在切除多节段椎管内肿瘤的同时、维护脊柱稳定性并巩固手术治疗效果的重要措施。Objective To discuss the way to protect neurological function and spinal stability in the microsurgery for the muhilevel spinal tumors. Methods The clinical data of 12 patients with multilevel spinal tumors, of whom, 8 had intramedullary tumors, 2 spinal subdural extramedullary and 2 epidural, were analyzed retrospectively. All the patients underwent microsurgery for the spinal tumors and intraspinal internal fixation including pedical screw fixation and lateral mass fixation for maintaining the stability of the spinal column under monitoring of somatosensory evoked potential from January, 2014 to January, 2016. Results The post operative pathological examination showed that of 12 spinal lesions, 5 were ependymomas, 2 lipomas, 2 meningiomas, 2 vascular malformations and 1 astrocytoma. The lesions were totally removed in 9 patients （81.8%） and subtotally in 3 patients including 2 patients with lipomas and 1 patient with astroeytoma. The nerve and main vessel were not damaged during the operation. There was no infection in all the patients. The neurological function was improved in 9 patients 2 weeks after the operation. There were pain in lower limbs, but muscle strength was not changed after the operation in 2 patients with lipomas. Following up from 1 to 10 months showed that the implantation grafts were not moved or fractured in all the patients. Conclusions Microsurgical technique combined with somatosensory evoked potential technology is beneficial to the total resection of the lesions and maintain of the neurological function in the patients with multilevel spinal lesions. The intraspinal internal fixation is very important to protection of the spinal stability during mierosurgery for the multilevel spinal tumors.

关 键 词：椎管内肿瘤 显微手术 脊柱内固定技术 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]