单一入路手术治疗巨大侵袭性脊柱神经鞘瘤  

Treatment of giant invasive spine schwannoma via variant single surgical approach

作　　者：胡旭民[1] 黄霖[1] 陈铿[1] 谢中瑜 王鹏[1] 蔡兆鹏[1] 赵敏[1] 唐永生[1] 沈慧勇[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨科,广东广州510120

出　　处：《中国骨与关节损伤杂志》2017年第7期677-679,共3页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(U1301223);中山大学临床医学研究5010计划项目(2015001)

摘　　要：目的探讨单一入路手术治疗巨大侵袭性脊柱神经鞘瘤的方法、疗效与安全性。方法回顾性分析自2013-01—2016-01采用单一入路手术治疗的11例巨大侵袭性脊柱神经鞘瘤。1例颈椎肿瘤行前路手术,2例颈椎肿瘤行后外侧入路手术。胸腰椎肿瘤4例中3例行后路手术,1例行前路手术。骶椎肿瘤4例行后路手术。结果本组手术时间120~290(210±55)min,术中出血量150~1 200(537±306)ml。1例S1神经根结扎后下肢肌力下降,双侧S4神经根结扎后出现二便功能障碍,术后半年逐渐恢复。本组均获得4~28(13.2±6.8)个月随访,所有患者均未发现肿瘤复发和转移,内固定位置良好。术前痛区VAS评分1~8(4.5±2.0)分,末次随访时VAS评分1~3(1.8±0.6)分;末次随访时疼痛较术前明显缓解,差异有统计学意义(P<0.05)。术前7例有神经功能障碍者ASIA评分:左侧39~49(44.5±3.9)分,右侧40~49(45.7±3.0)分;末次随访ASIA评分:左侧42~49(46.7±2.5)分,右侧45~49(47.4±1.4)分;手术前后ASIA评分差异无统计学意义(P>0.05)。结论单一入路手术能够完整切除巨大侵袭性脊柱神经鞘瘤,彻底减压并重建脊柱稳定性,疗效确切,并发症少。Objective To investigate the selection, methods, efficacy and risk of total resection and reconstruction of giant invasive spinal sehwannomas via variant single surgical approach. Methods Eleven cases of schwannomas, enrolled from Jan. 2013 to Jan. 2016, received operations via variant single surgical approach, were retrospectively studied, including 1 anterior cervical case, 2 posterolateral cases, 4 posterior thoracolumbar cases, and 4 posterior sacral cases. Results The operating time was 120-290（210±55）mins. Blood loss was 150-1 200（537±306）nd. Ligation of $1, bilateral $4 and below, and unilateral $3 and below caused dysfunction of sensation, movement, bladder and bowel. Control of bowel recovered in 6 months. The follow-up period was 4-28 （13.2±6.8）months. All patients maintained good instrument position and no tumorous recurrence and metastasis happened. There was significant difference in VAS before and after operation, （1-8, 4.5±2.0） and （1-3, 1.8±0.6） respectively（P 〈0.05）. Of all 7 nerve-imparted patients, their pre-operative ASIA score of left body was 39-49 （44.5±3.9）, and right 40-49 （45.7±3.0）. Their post-operative score of left body was 42-49 （46.7±2.5） and right 45-49 （47.4± 1.4）, which had no significant difference （P 〉0.05）. Conclusion Single surgical approach is effective and safe in the total resection of giant invasive spine schwannoma and reconstruction.

关 键 词：脊柱 巨大侵袭性神经鞘瘤 单一入路 前路 后外侧入路 后路 

分 类 号：R681.5[医药卫生—骨科学]