半椎板入路显微手术治疗颈椎椎管内肿瘤

Microsurgery through hemilaminectomy approach for cervical intraspinal tumors (a report of 52 cases)

目的探讨半椎板入路显微手术治疗颈椎椎管内肿瘤的优点与不足。方法对52例颈椎椎管内肿瘤运用半椎板入路(其中37例采用单纯半椎板入路,15例哑铃形肿瘤采用半椎板及小关节切除入路)显微手术切除肿瘤。随访其术后神经功能、肿瘤复发与脊柱畸形情况。结果 51例肿瘤获全切除,1例肿瘤次全切除,没有出现新的神经功能损害的症状。术后随访10～60个月,平均48个月,1例肿瘤复发,1例失访。38例复查颈椎过伸和过屈位平片,未见脊柱畸形,但有小关节破坏者颈椎活动度较大。结论半椎板入路显微手术治疗颈椎管内肿瘤对后部结构破坏小,有利于维持脊柱的稳定性,但有小关节破坏时,应长期随访其稳定性变化。本术式术野暴露局限,仅限于偏于一侧生长的髓外肿瘤。

Objective To investigate the advantages and defects of microsurgery through hemilaminectomy approach for the cervical intraspinal tumors.Method Microsurgery through hemilaminectomy approach was performed in 37 patients with cervical intraspinal tumors.Microsurgery through hemilaminectomy and facetectomy approaches was performed in 15 patients with dumbbell intraspinal tumors.The curative effects were observed.Results Of 52 patients,51 received total removal of the tumors,and 1 subtotal.No new neurological impairment appeared in all the patients after the operation.Fifty-one patients were followed up from 10 to 60 months.The tumor recurred in 1 patient during following up.No spinal deformity was found on the cervical lordotic and kyphotic position films in 38 patients,but the range of cervical spine motion was greater in the patients undergoing facetectomy than that in the patients without facetectomy.Conclusions Hemilaminectomy with less damage to the posterior structure is beneficial to maintaining the stability of the spinal column after the operation in the patients with cerrical intraspinal tumors.The patients undergoing facetectomy should be long followed-up to observe the spinal stability.The hemilaminectomy may be applicable to the extramedullary tumors biased to unilateral spinal column because of the limited exposure.