经后路椎板减压脊柱椎管内肿瘤手术切除的临床分析

Efficacy of posterior laminectomy approach for treating intraspinal tumor

目的评价通过后路椎板切除减压行脊柱椎管内肿瘤手术切除的临床疗效。方法回顾性分析2000年1月至2008年1月于长征医院骨科、长征闸北分院骨科收治259例脊柱椎管内肿瘤(髓内肿瘤除外),男166例,女93例,年龄23～85岁,平均52.3岁;颈段71例,胸段90例,腰、骶段98例,247例位于髓外硬膜下,12例位于硬膜外。除上胸椎(16例)外均行后路椎弓根内固定,椎板切除减压入路手术治疗,硬膜外肿瘤直接切除,硬膜内者行硬膜切开肿瘤切除并缝合硬膜囊并行关节突关节植骨融合。手术节段切口内置入负压引流并术后抗感染。肿瘤组织送病理。术后随访48～120个月,平均随访期73.5个月。随访复查MRI观察肿瘤有无复发,评价神经功能恢复情况,复查X线片观察脊柱稳定性。结果 259例病理结果 153例为神经鞘瘤(59.1%),68例为神经纤维瘤(26.2%),脊膜瘤21例(8.1%),脂肪瘤10例(3.9%),转移瘤2例(0.8%),血管瘤5例(1.9%);术后24例出现脑脊液漏,1例出现椎管内感染,对症加强治疗后痊愈。随访脊柱X线片未见脊柱椎体间失稳。复查MRI未见肿瘤复发。随访期1例椎管内转移瘤因原发肿瘤死亡。患者临床症状及神经功能明显改善。结论经后路椎板切除减压入路能充分显露脊柱椎管内肿瘤,彻底切除肿瘤,采用此入路手术治疗椎管内肿瘤临床疗效满意。

Objective To evaluate the efficacy of posterior laminectomy approach for treating intraspinal tumor. Methods From January,2000 to January,2008,259 patients（166 males,93 females） with intraspinal tumor were analyzed retrospectively.The age range was from 23 to 85 years（average 52.3years）.There were 71 cases in the cervical spine,90 cases in the thoracic spine and 98 cases in the lumbosacral segment.Of which,247 cases were in intradural extramedullary and 12 cases were in epidura1.All the patients underwent transpedicle screws fixation and total laminectomy.If the tumor was in intraspinal and epidural,it was resected directly.If the tumor was in intradural extramedullary,the dural was cut longitudinally and the tumor was resected.The dural was sutured and autogeneic bone was planted between zygapophysial joints.The negative pressure drainage was used to drain the cerebrospinal fluid in the cut.Anti-infection treatment was necessary postoperation.The tumor tissue was tested pathologically.All the patients were followed up for 48~120 months（average 73.5 months）.The neurological function was evaluated and the spinal stability was evaluated by X-ray films.The rumor recurrence was evaluated by MRI examination. Results The intraspinal tumors included Neurilemmom in 153 cases（59.1%）,neurofibroma in 68（26.2%） meningiomas in 21 cases（8.1%）,lipoma in 10 cases（3.9%）,metastatic tumors in 2 cases（0.8%）,hemangioma in 5 cases（1.9%）,respectively.There were 24 cases with leakage of cerebrospinal fluid through the cut and one case with intraspinal infection.The patients recovered after treatment.There was no spinal instability observed during the follow up period and no tumor recurrence by MRI.One patient died for original malignant tumor.The neurological function recovered in the follow up period. Conclusions The posterior laminectomy approach can explore the intraspinal tumor thoroughly,which is convenient for tumor resection completely,as well as improving the clinical outcome.