CAJ | 학술논문

目的探讨枕颈部髓外肿瘤的手术疗效分析及脊柱稳定性重建的意义.方法回顾性分析2007年1月至2010年7月接受手术治疗的15例枕颈部髓外肿瘤患者资料,男7例,女8例;年龄21～72岁,平均44.6岁;均为硬膜下髓外肿瘤,其中7例位于脊髓背外侧,5例位于侧面,3例位于腹外侧.Frankel分级:C级4例,D级8例,E级3例.术前日本骨科协会(Japanese Orthopaedic Association,JOA)评分为(10.5±3.6)分.按枕颈部解剖特点,分为位于延髓至C1水平的肿瘤5例,位于C1,2水平的肿瘤10例.切除肿瘤后,位于延髓至C1水平的肿瘤行枕颈固定,位于C1.2水平的肿瘤行寰枢椎固定.比较术前和末次随访的Frankel分级、JOA评分、C0～2角及C2～7角度数,分析患者术后的症状改善及术式选择的特点.结果 15例患者均获得随访,随访时间2～4年,平均2.8年.术后影像学检查示肿瘤切除完整,植骨融合良好.术后病理检查示神经鞘瘤10例,脊膜瘤3例,神经纤维瘤2例.末次随访时,2例由Frankel分级C级恢复到D级,2例由C级恢复到E级,6例由D级恢复到E级,2例术前D级的患者术后无改变;JOA评分为(15.6±1.6)分,改善率为80.7％±17.4％.术前C0～2角27.0°±4.1°,C2～7角16.8°±12.7°;末次随访时C0～2角27.6°±8.8°,C2～7角10.2°±6.8°,均未见显著性差异.结论手术切除枕颈部髓外肿瘤能充分解除脊髓压迫,改善脊髓压迫症状;脊柱稳定性重建能保持枕颈部稳定性,防止颈椎后凸畸形.
목적 탐토침경부수외종류적수술료효분석급척주은정성중건적의의.방법 회고성분석2007년1월지2010년7월접수수술치료적15례침경부수외종류환자자료,남7례,녀8례;년령21～72세,평균44.6세;균위경막하수외종류,기중7례위우척수배외측,5례위우측면,3례위우복외측.Frankel분급:C급4례,D급8례,E급3례.술전일본골과협회(Japanese Orthopaedic Association,JOA)평분위(10.5±3.6)분.안침경부해부특점,분위위우연수지C1수평적종류5례,위우C1,2수평적종류10례.절제종류후,위우연수지C1수평적종류행침경고정,위우C1.2수평적종류행환추추고정.비교술전화말차수방적Frankel분급、JOA평분、C0～2각급C2～7각도수,분석환자술후적증상개선급술식선택적특점.결과 15례환자균획득수방,수방시간2～4년,평균2.8년.술후영상학검사시종류절제완정,식골융합량호.술후병리검사시신경초류10례,척막류3례,신경섬유류2례.말차수방시,2례유Frankel분급C급회복도D급,2례유C급회복도E급,6례유D급회복도E급,2례술전D급적환자술후무개변;JOA평분위(15.6±1.6)분,개선솔위80.7％±17.4％.술전C0～2각27.0°±4.1°,C2～7각16.8°±12.7°;말차수방시C0～2각27.6°±8.8°,C2～7각10.2°±6.8°,균미견현저성차이.결론 수술절제침경부수외종류능충분해제척수압박,개선척수압박증상;척주은정성중건능보지침경부은정성,방지경추후철기형.
Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.