椎管内肿瘤的手术治疗体会及疗效观察

Surgical treatment of intraspinal tumors

目的 探讨椎管内肿瘤的不同手术方式及远期效果.方法 回顾分析423例椎管内肿瘤临床资料并进行随访分析,评估不同术式的临床效果.结果 有效随访的205例：采用后正中入路全椎板切除术135例,其中有7例由于术后骨性结构缺失而出现脊柱退变加剧,2例术后肿瘤复发,2例出现下肢疼痛麻木;后正中入路全椎板切除＋椎板棘突复合体复位重建手术45例,随访未见不适;后正中入路全椎板切除＋钉棒系统内固定手术20例,1例术后出现下肢牵扯样疼痛,持续2个月后逐渐缓解;半椎板切除手术5例,术后痊愈.结论 手术为首选治疗策略,以保全患者神经功能及脊柱的稳定性为主要目标,行个体化治疗,以达到最好的治疗效果.

Objective To discuss the operation approaches and long-term outcome of the intraspinal tumor.Methods To evaluate the clinical effect of different operative methods through a retrospective analysis of 423 cases of intraspinal tumors and follow-up analysis.Results 205 cases were with valid follow-up：135 cases were treated with the posterior median approach laminectomy,including 7 cases with postoperative bone structure deletion and spinal degeneration aggravated,2 cases recurred after operation,2 cases of lower limbs pain;45 cases with posterior median approach total laminectomy and lamina complex reduction and reconstruction operation,follow-up no discomfort; 20 cases with posterior median approach total laminectomy and pedicle screw internal fixation operation,including 1 cases of postoperative lower limbs dragging pain,gradually easing after two months; 5 cases with semi-laminectomy operation,postoperative recovery.Conclusions Operation is the preferred treatment strategy,and the main aim is to keep the preservation of neurological function and the stability of spine.Individual treatment should be preferred.