外科治疗颈椎椎管内肿瘤方法及临床疗效

Surgical treatment of 27 cervical intraspinal tumor

目的探讨颈椎椎管内肿瘤的外科治疗方法及内固定对其临床疗效的影响。方法回顾分析27例我院脊柱骨科与神经外科2011年1月~2014年12月收治的颈椎椎管内肿瘤临床资料,13例行肿瘤切除及内固定手术(内固定组),14行单纯肿瘤切除手术(无内固定组)。两组患者性别、年龄及病程比较,差异均无统计学意义(P>0.05)。分别于术前和术后随访时按日本骨科协会(JOA)颈椎疗效评定标准17分评分法对患者进行疗效评估,并复查颈椎X线平片及颈椎MRI,了解手术对颈椎椎管内肿瘤的治疗效果及内固定对其的影响。结果所有患者均行外科手术切除肿瘤,术后1~56个月随访,平均29.7个月,除2例复发外,其余患者术后根性痛、感觉障碍、运动障碍及反射异常较术前明显改善,JOA评分由术前11.7分升高至末次随访时14.9分(P<0.05)。两组患者术前及末次随访时JOA评分改善率比较差异均无统计学意义(P>0.05)。未行内固定治疗的患者术后有出现鹅颈畸形的现象。结论无论是否行内固定,颈椎椎管内肿瘤手术治疗可以取得较好的临床效果。

Objective To investigate the surgical treatment of cervical intraspinal tumor and the influence of instrumentation. Methods A total of 27 patients with cervical intraspinal tumor surgically treated from January 2011 to December 2014 were retrospectively analyzed . Patients were divided into the internal fixation group （13 cases ）and the simple tumor resection group（14 cases）. No significant differences were found in gender, age, disease duration between 2 groups （P〉0.05）. JOA score was analyzed before and after operation, the cervical spine radiographs and MR images were recorded. Results All tumors in the 27 patients were primarily removed. The follow-up time ranged from 1 to 56 months with an average of 29.7 months. Radicular pain, sensory disturbances, movement disorders and altered reflexes were significantly improved, JOA score increased from 11.7 points preoperatively to 14.9 points at the end of the follow-up （P〈0.05）. No significant difference was found in JOA score improvement rate between 2groups （P〉0.05）. In the simple tumor resection group, 2 cases appeared recurvation deformity in cervical spine. Conclusion Surgical treatment can achieve good clinical efficacy in the treatment of cervical intraspinal tumor with or without fixation.