CAJ | 학술논문

目的探讨经皮套管椎旁入路显微切除颈椎椎管内占位的手术方式和临床疗效.方法回顾性分析福建医科大学附属协和医院神经外科2011年11月至2014年2月收治的18例颈椎椎管内髓外占位患者,其中神经鞘瘤13例,脊膜瘤3例,肠原性囊肿1例,单纯性囊肿1例.全麻后在神经电生理监测下经皮套管椎旁入路显微切除颈椎椎管内髓外占位.分析手术时间、出血量、术后切口局部疼痛时间;记录术前1d、术后1d、3d、5d肌酸磷酸激酶水平(CPK-MM);于术前1d、术后1d、5d和术后6个月分别采用McCormick评分标准评价脊髓功能,以及采用疼痛视觉模拟量表(VAS)评估切口局部疼痛程度;于术后1周行颈椎CT三维重建;于术前、术后1周、术后6个月行颈椎MRI平扫加增强检查.结果 18例椎管内占位完全切除,无神经损伤发生,McCormick评分及VAS评分较术前改善(P＜0.05);术后1 d CPK-MM升高,术后5d下降至术前1d水平,差异无统计学意义(P＜0.05);MRI平扫加增强检查未见占位残留及复发,CT三维重建显示椎板开窗范围,无损伤关节突和脊椎的稳定性;随访期间未见脊椎畸形发生.结论在神经电生理监测下经皮套管椎旁入路显微切除颈椎椎管内髓外占位,既能最大程度地避免影响肌肉、关节突以及脊椎稳定性,也能达到椎管内占位的全切除,具有创伤小、住院时间短、术后恢复快、术后脊椎稳定性好等优点.
목적 탐토경피투관추방입로현미절제경추추관내점위적수술방식화림상료효.방법 회고성분석복건의과대학부속협화의원신경외과2011년11월지2014년2월수치적18례경추추관내수외점위환자,기중신경초류13례,척막류3례,장원성낭종1례,단순성낭종1례.전마후재신경전생리감측하경피투관추방입로현미절제경추추관내수외점위.분석수술시간、출혈량、술후절구국부동통시간;기록술전1d、술후1d、3d、5d기산린산격매수평(CPK-MM);우술전1d、술후1d、5d화술후6개월분별채용McCormick평분표준평개척수공능,이급채용동통시각모의량표(VAS)평고절구국부동통정도;우술후1주행경추CT삼유중건;우술전、술후1주、술후6개월행경추MRI평소가증강검사.결과 18례추관내점위완전절제,무신경손상발생,McCormick평분급VAS평분교술전개선(P＜0.05);술후1 d CPK-MM승고,술후5d하강지술전1d수평,차이무통계학의의(P＜0.05);MRI평소가증강검사미견점위잔류급복발,CT삼유중건현시추판개창범위,무손상관절돌화척추적은정성;수방기간미견척추기형발생.결론 재신경전생리감측하경피투관추방입로현미절제경추추관내수외점위,기능최대정도지피면영향기육、관절돌이급척추은정성,야능체도추관내점위적전절제,구유창상소、주원시간단、술후회복쾌、술후척추은정성호등우점.
Objective To investigate the operation methods and efficacy analysis of paraspinal approach by percutaneous tubular retractor system for microsurgical resection of space-occupying lesions in cervical vertebra canals.Methods Eighteen patients with space-occupying lesions in cervical spinal canals treated at the Department of Neurosurgery,the Affiliated Union Hospital of Fujian Medical University from November 2011 to February 2014 were analyzed,including 13 patients with schwannoma,3 with meningioma,1 with enterogenous cysts,and 1 with simple cyst.Under neurophysiological monitoring,their space-occupying lesions in cervical spinal canals were treated via paraspinal approach by percutaneous tubular retractor system after general anesthesia.The operation time,bleeding volume,and local pain time of postoperative incision were analyzed.The creatine phosphokinase (CPK-MM) levels were recorded at 1 day before surgery,and at 1,3,and 5 days after surgery.The spinal cord functions were evaluated respectively using McCormick scoring criteria at 1 day before surgery and at 1 day,5 days and 6 months after surgery.The pain visual analogue scale (VAS) was used to analyze the pain degree of local incision.The cervical CT three-dimensional reconstruction was performed at 1 week after surgery.Cervical MRI scan and enhanced scan were performed at one week before and after procedure,and at 6 months after procedure.Results Eighteen patients with intraspinal occupying lesions were totally removed without nerve injury.The postoperative McCormick scores and VAS scores were improved compared with before procedure (P ＜0.05).The CPK-MM level increased at 1 day after operation and it decreased to the level of before operation at 5 days after procedure.There was no significant difference (P ＜ 0.05).MRI scan plus enhanced examination did not reveal occupying residue and recurrence.CT three-dimensional reconstruction showed the range of vertebral lamina fenestration.No injury of articular process and spinal stabilities were observed.No spinal deformity occurred during the follow-up period.Conclusions Under neurophysiological monitoring,paraspinal approach by percutaneous tubular retractor system for microsurgical resection of extramedullary occupying lesions in cervical spinal canals has the advantages of less injury,shorter hospital stay,faster recovery,and better postoperative spinal stability.