CAJ | 학술논문

目的探讨在术中B超、高速磨钻以及超声刀等技术辅助下,经半椎板入路对椎管内肿瘤的治疗效果.方法回顾性分析35例椎管内肿瘤患者的临床资料,所有患者均采用半椎板入路进行手术治疗,手术前均行X线下病变相应节段的椎间隙定位,并采用术中B超确认肿瘤位置和边界,对于半椎板暴露欠佳者采用高速磨钻或超声刀磨除入路侧棘突根部以获取良好的操作视野,病变位于髓内者辅以神经电生理监测.结果 35例椎管内肿瘤患者中32例肿瘤完全切除,3例次全切除.35例患者中随访28例,第一阶段(术后1～3个月)随访,改善25例,无变化2例,加重1例；第二阶段(术后6个月至2年)随访,所有病例均无变化,即没有发现脊柱不稳定.结论随着神经电生理监测、高速磨钻、超声刀等显微器械的发展,半椎板入路应用适应证逐渐增宽,能适用于大部分椎管内占位性病变,术后对患者脊柱稳定性无明显影响,但对于基底较宽的脊膜瘤有时难以全切,不可勉强.
목적 탐토재술중B초、고속마찬이급초성도등기술보조하,경반추판입로대추관내종류적치료효과.방법 회고성분석35례추관내종류환자적림상자료,소유환자균채용반추판입로진행수술치료,수술전균행X선하병변상응절단적추간극정위,병채용술중B초학인종류위치화변계,대우반추판폭로흠가자채용고속마찬혹초성도마제입로측극돌근부이획취량호적조작시야,병변위우수내자보이신경전생리감측.결과 35례추관내종류환자중32례종류완전절제,3례차전절제.35례환자중수방28례,제일계단(술후1～3개월)수방,개선25례,무변화2례,가중1례；제이계단(술후6개월지2년)수방,소유병례균무변화,즉몰유발현척주불은정.결론 수착신경전생리감측、고속마찬、초성도등현미기계적발전,반추판입로응용괄응증축점증관,능괄용우대부분추관내점위성병변,술후대환자척주은정성무명현영향,단대우기저교관적척막류유시난이전절,불가면강.
Objective To investigate the therapeutic effect of the hemilaminectomy approach in intraspinal tumor with the help of intraoperative ultrasound,high-speed drill and ultrasound knife.Methods Clinical data of 35 cases with the intraspinal tumor were analyzed retrospectively.All the patients were treated by hemilaminectomy approach,the position of the lesions were fixed by preoperative X-ray and intraoperative ultrasound,root of the spinous process were removed in order to achieve adequate visual field by high-speed drill and ultrasound knife.Electrophysiologic monitoring were used if the lesions were in the spinal cord.Results Total surgical resection was achieved in 32 cases,gross total resection was in 3 cases.Twenty-eight of the 35 cases were followed up.The symptom alteration of the first period ( 1 - 3 months postoperative):improved in 25 cases,no changed in 2 cases,aggravated in 1 case.The symptom alteration of the second period (6-24 months postoperative):no changed in all cases,no stability change of the vertebral column had been found.Conclusions Followed with the development of the electrophysiologic monitoring,high-speed drill,intraoperative ultrasound,the indication of the hemilaminectomy and have no influence of the spinal stability.However,to spinal meningioma which have a wide base,the hemilaminectomy approach may not adapt.