髓外硬膜下肿瘤的手术治疗与临床效果

Diagnosis and surgical treatment of subdural-extramedullary tumor

[目的]探讨髓外硬膜下肿瘤的诊断、手术方法和临床效果。[方法]患者45例,男28例,女17例;年龄24～71岁,平均45岁。术前影像学检查结果示椎管内髓外硬膜下占位。行后路常规手术入路,全椎板切除,尽量保留小关节突,打开硬膜,直视下神经剥离子分离肿瘤并切除,而后行椎弓根螺钉固定,恢复脊柱稳定性。[结果]随访6～42个月,平均26.2个月。术后Otani’S分级优11例,良18例,优良率64.44%,其中初次就诊至确诊并手术时间在1个月内的患者术后Otani’S等分级方法优良率(84.62%)优于因误诊、漏诊而延迟手术的1～6个月组(64.29%)及>6个月组(50%)。[结论]手术切除肿瘤是治疗髓外硬膜下肿瘤的首选方法,早期确诊及时手术治疗是获得良好临床效果的关键。

[Objective]To investigate the diagnosis,surgical procedure and clinical effect for the subdural extramedullary tumor. [Methods]Forty-five patients （28 males and 17 females,age ranged from 24-71 years with an average of 45 years ） were treated with tumour extirpation. MRI showed subdural extramedullary tumor before surgery. The spine was exposed through a standard posterior approach,and the dura matter was opened after lamninectomy. The tumor was separated and removed from the dura matter. Pedicle screw fixation was performed to restore the stability of spine. [Results]The patients were followed up from 6 to 42 months with an average of 26.2 months. The postoperative recovery of neurological function was measured with Otani scores. The clinical result was excellent in 11 patients,good in 18 and fair in 12,resulting in 64.44% of good to excellent rate. The good to excellent rate had an advantage in patients （84.62%） operated on within one month after first visit over that of patients （64.29%） who had a misdiagnosis for 1~6 months and the patients （50.00%） for more than 6 months.[Conclusion]Removal is the method of choice for patients with subdural extramedullary tumor. Early diagnosis and removal are key factors to get a good clinical effect.