CAJ | 학술논문

目的探讨经后路一期行腰椎椎管内外沟通性哑铃型肿瘤的手术方法及效果.方法回顾性分析北京大学第三医院神经外科2006 -2011年的10例腰椎哑铃型肿瘤,肿瘤位于L4～5水平6例、L2～3水平3例、L5～S1水平1例.临床上以根性疼痛为主要表现.根据肿瘤主体位置,选择适宜入路一期行肿瘤切除术,其中经后旁正中-峡部外侧入路3例；经后正中椎板切除入路4例；经后路椎板-小关节突切除入路加钉棒系统内固术3例.结果本组10例肿瘤均完全切除,手术耗时1.5-4.1h,出血量90 ～300 ml,无手术并发症.术前根性疼痛症状术后缓解或消失,病理检查9例为神经鞘瘤、1例为神经纤维瘤.随访时间3个月至5年,1例患者术后2个月始伤口周围疼痛,术后8个月消失；另外9例手术后无不适.复查MRI肿瘤复发率为0,腰椎序列及曲度完好.结论腰椎哑铃型肿瘤,多为神经鞘瘤或神经纤维瘤,其包膜完整,边界清楚.手术应根据术前医学影像学资料选择适宜人路,一期切除肿瘤.
목적 탐토경후로일기행요추추관내외구통성아령형종류적수술방법급효과.방법 회고성분석북경대학제삼의원신경외과2006 -2011년적10례요추아령형종류,종류위우L4～5수평6례、L2～3수평3례、L5～S1수평1례.림상상이근성동통위주요표현.근거종류주체위치,선택괄의입로일기행종류절제술,기중경후방정중-협부외측입로3례；경후정중추판절제입로4례；경후로추판-소관절돌절제입로가정봉계통내고술3례.결과 본조10례종류균완전절제,수술모시1.5-4.1h,출혈량90 ～300 ml,무수술병발증.술전근성동통증상술후완해혹소실,병리검사9례위신경초류、1례위신경섬유류.수방시간3개월지5년,1례환자술후2개월시상구주위동통,술후8개월소실；령외9례수술후무불괄.복사MRI종류복발솔위0,요추서렬급곡도완호.결론 요추아령형종류,다위신경초류혹신경섬유류,기포막완정,변계청초.수술응근거술전의학영상학자료선택괄의인로,일기절제종류.
Objective To investigate the surgical technique and to evaluate the outcome of one stage resection for intra - and extra - dumbbell - shaped tumor of the lumbar spine.Methods 10 patients with dumbbell - shaped tumors of lumbar spine from 2006 to 2011treated surgically were analyzed retrospectively.The tumor located at the level of L4-5 in 6 cases,L2-3 in 3 cases and L5 - S1in 1case.Back pain and radicular neuralgia along the affected nerve root were the main clinical manifestation.There were three surgical approaches according to the main location of the tumors included para - middle approach through exra - par in 3 cases,posterior laminectomy in 4 cases,and posterior laminectomy and facetactomy plus instrumentation and fusion in 3 cases respectively.Results 10 operations had been performed with gross total of tumor resection in all cases.The timing of procedures was from 1.5 to 4.1hours.The volume of bleeding during operation was around 90 to 300 ml.There was no surgical complications happened.Clinically,the symptoms of back pain and radicular neuralgia prior to operation were relieved or disappeared.The histological examination showed Schwannoma in 9 cases,and neurofibroma in 1case.The period of follow - up was ranged from 3 months to 5 years.There was 1patient with pain surrounding the incision area happened in 2 months post - operation and that was disappeared 8 months post - operation.Neurological status had been stable during the followed - up period. The recurrence rate was 0. The alignment and lordosis of lumbar spine was intact during the follow - up.Conclusions The Schwannoma and neurofibroma were the most common pathological type of dumbbell - shaped tumor located at the lumbar spine and that can be well revealed and removed through appropriate approaches according to the pre operation MRI manifestation.