CAJ | 학술논문

目的探讨单开门椎管成形、重建椎管后部结构治疗颈椎管髓外硬膜内良性肿瘤的可行性及临床疗效.方法 2001年1月至2013年1月,应用单开门椎管成形、重建椎管后部结构方法治疗颈椎管髓外硬膜内肿瘤87例,其中采用单开门掀起椎板、显微切除椎管内占位、椎板棘突复合体原位复位78例,单开门椎管扩大成形、切除肿瘤后微型钛板固定椎板重建椎管9例.结果随访12 ～58个月,平均26.3个月.椎板开门节段数2～5个,平均2.5个.平均手术时间92 min (62～136 min),术中平均失血80 ml(50～260 ml).术后临床症状完全或大部分消失.所有病例均复查X线片未见脊椎失稳征象,63例复查CT显示复位的椎板棘突复合体无内陷移位,75例复查MRI显示颈椎管髓外硬膜内肿瘤无复发,无椎管狭窄、黄韧带和硬脊膜增厚.脊椎曲度的变化:颈椎曲度由术前的(17.8±8.4)°变为术后12个月时的(16.1±7.8)°,手术前后比较差异无统计学意义(P＞0.05).结论单开门椎管成形术治疗颈椎管髓外硬膜内肿瘤,对肿瘤暴露及切除效果满意的同时,保存了一侧椎板的连续性,椎板棘突韧带复合体复位后恢复了脊椎的原有解剖结构,对脊椎的稳定性影响小,可避免椎板切除术后脊椎畸形的发生.
목적 탐토단개문추관성형、중건추관후부결구치료경추관수외경막내량성종류적가행성급림상료효.방법 2001년1월지2013년1월,응용단개문추관성형、중건추관후부결구방법치료경추관수외경막내종류87례,기중채용단개문흔기추판、현미절제추관내점위、추판극돌복합체원위복위78례,단개문추관확대성형、절제종류후미형태판고정추판중건추관9례.결과 수방12 ～58개월,평균26.3개월.추판개문절단수2～5개,평균2.5개.평균수술시간92 min (62～136 min),술중평균실혈80 ml(50～260 ml).술후림상증상완전혹대부분소실.소유병례균복사X선편미견척추실은정상,63례복사CT현시복위적추판극돌복합체무내함이위,75례복사MRI현시경추관수외경막내종류무복발,무추관협착、황인대화경척막증후.척추곡도적변화:경추곡도유술전적(17.8±8.4)°변위술후12개월시적(16.1±7.8)°,수술전후비교차이무통계학의의(P＞0.05).결론 단개문추관성형술치료경추관수외경막내종류,대종류폭로급절제효과만의적동시,보존료일측추판적련속성,추판극돌인대복합체복위후회복료척추적원유해부결구,대척추적은정성영향소,가피면추판절제술후척추기형적발생.
Objective To investigate the feasibility and clinical efficacy of single pen-door laminoplasly and reconstruction of the posterior structure of spinal canal for the treatment of cervical intradural extramedullary tumors.Methods From January 2001 to January 2013,87 patients with cervical intradural extramedullary tumor were treated by using the single open-door laminoplasty,reconstruction of the spinal posterior structure method,and 78 of them were treated with the single open-door setting off lamina,microsurgical resection of intraspinal occupying,lamina and spinous process complex in situ reduction,9 were treated with single open-door laminoplasty and reconstruction of the spinal canal with mini titanium plate fixation after removal of the tumors.Results They were followed up for 12 to 58 months (mean 26.3 months).The numbers of lamina open-door segments were 2 to 5 (mean 2.5).The mean operation time was 92 min (range 62-136 min);the intraoperative mean blood loss was 80 ml (range 50-260 ml).The postoperative clinical symptoms of the patients disappeared completely or mostly.Postoperative X-ray examinations of all cases did not show the signs of spinal instability,CT scan of 63 cases revealed that spinous process-lamina complex of reduction did not have invagination and displacement.MRI of 75 cases showed that their cervical intradural extramedullary tumors did not have recurrence.No spinal canal stenosis,yellow ligament,and dura thickening were observed.The changes of spinal curvature:cervical curvature decreased from preoperative 17.8 ±8.4° to 16.1 ±7.8° at 12 months after procedure.There was no significant difference between before procedure and after procedure (P ＞ 0.05).Conclusions Single open-door laminoplasty for the treatment of cervical intradural extramedullary tumor has satisfactory effect for tumor exposure and resection,at the same time;it saves the continuity of the lamina on one side.After spinous process-lamina complex of reduction,the original anatomical structures of spinal were recovered.It has little impact on the stability of the spine and can avoid the occurrence of spinal deformity after laminectomy.