椎管内外沟通瘤的手术治疗(附98例分析)

Surgery for intra-and extra-vertebral canal communicating tumors(report of 98 cases)

目的探讨椎管内外沟通瘤的临床特征和手术方法及疗效。方法回顾性分析2012年4月至2018年4月手术治疗的98例椎管内外沟通瘤的临床资料。采取单纯后正中入路92例、颈外侧入路4例和前后联合入路2例;术中同期行脊椎固定术35例,其中椎板成形术25例,颈段侧块螺钉内固定术或胸腰段椎弓根螺钉内固定术10例。结果肿瘤全切除85例,部分切除13例;经单纯后正中入路手术肿瘤全切除率为78.3%(72/92),经颈外侧入路4例和前后联合入路2例肿瘤均全切除。术后病理证实神经鞘瘤77例,神经纤维瘤7例,脊膜瘤6例,节细胞神经瘤5例,海绵状血管瘤1例,孤立性纤维瘤1例,脂肪瘤1例。所有病人术后随访6~84个月,平均47.6个月。临床症状改善89例,肿瘤复发4例,发生并发症7例。未行任何维持脊柱稳定措施的病人脊柱畸形发生率(17.46%)明显高于颈段侧块或胸腰段椎弓根螺钉内固定术(0%,P<0.05)以及椎板成形术(4.00%,P<0.05)。结论椎管内外沟通瘤可经不同手术入路手术全切肿瘤,其中骨质破坏严重者可通过椎板成形术或椎弓根及椎体内螺钉内固定植入术重建脊柱稳定性,可减少术后脊柱畸形发生率。

Objective To analyze the clinical features and surgical strategies of intra- and extra- vertebral canal communicating tumors. Methods The clinical data of 98 patients with intra- and extra- vertebral canal communicating tumor were analyzed retrospectively. The tumors were removed by the surgery via posterior midline approach in 92 patients, via the lateral approach in 4 patients and via posterior and anterior approach in 2 patients. Thirty-five patients underwent spinal fixation （laminoplasty, lateral mass screw internal fixation or thoracolumbar pedicle screw fixation）. Results Of these 98 patients, 85 received total resection of the tumor and 13, who underwent the surgery via posterior midline approach, received partial resection of the tumors. The postoperative symptoms improved differently in degrees in 89 patients. Patients with spine internal fixation had no secondary spine deformity. The incidence of spinal deformity was 4.00% （1/25） in the patients undergoing laminectomy. The incidence of spinal deformity in patients who did not receive reconstruction of spinal stability was 17.46% （11/63）. Conclusions The intra- and extra- vertebral canal communicating tumors can be totally removed by the surgery via different surgical approaches. The reconstruction of spinal stability including internal fixation and fusion should be recommended in the intra- and extra-vertebral canal communicating tumors patients with bony erosion.