腰椎管内骨性占位经皮脊柱内镜治疗分析

Endoscopic Treatment of Lumbar Spinal Canal

目的探讨腰椎管内骨性占位经皮脊柱内镜显微手术疗效。方法回顾性分析2017年1月-2019年2月该院神经外科15例腰椎管内骨性占位患者的临床资料。肖氏改良分区分期:I期6例,Ⅱ期5例,Ⅲ期3例,Ⅳ期1例。手术方式:后正中半椎板入路9例,其中内固定2例;后正中人路棘突椎板复合体原位回植椎管成形术3例;颈前入路3例,其中内固定1例。术后采用椎管MRI检查评价患者的切除情况,采用脊柱CT三维重建或脊柱x线检查评价脊柱稳定情况,采用Frankel分级标准评价患者的脊髓功能恢复情况。结果该组15例患者均在显微镜下一期全部切除。肿瘤性质:神经鞘瘤14例,神经节细胞瘤1例。术后无脑脊液漏及切口感染。术后Frankel分级显示,患者脊髓功能恢复D级4例,E级11例。随访1~24个月,平均13个月,无肿瘤复发及脊柱失稳。结论颈椎椎管内外沟通性肿瘤应选择合适的手术入路,显微镜下可一期全切肿瘤,必要时行相应的椎体重建和脊柱内固定术以维持脊柱稳定性。

Objective To investigate the effect of percutaneous spinal endoscopic microsurgery in the lumbar spinal canal. Methods The clinical data of 15 patients with lumbar spinal canal occlusion in hospital neurosurgery from January 2017 to February 2019 were retrospectively analyzed. Xiao's improved zoning staging: 6 cases in stage I, 5 cases in stage II, 3 cases in stage III, and 1 case in stage IV. Surgical procedure: 9 cases of posterior median semi-laminar approach, including 2 cases of internal fixation;3 cases of posterior median approach for spine process and laminectomy;3 cases of anterior cervical approach, including internal fixation 1 case. Spinal MRI was used to evaluate the resection of the patients. Spinal CT three-dimensional reconstruction or spinal x-ray examination was used to evaluate the stability of the spine. The Frankel grading criteria were used to evaluate the recovery of spinal cord function. Results All 15 patients in this group were all removed in the next stage of the microscope. Tumor properties: 14 cases of schwannomas and 1 case of ganglioneuroma. There was no cerebrospinal fluid leakage and wound infection after operation. Postoperative Frankel grading showed that the patient's spinal cord function recovered from grade D in 4 cases and grade E in 11 cases. The patients were followed up for 1-24 months, with an average of 13 months. There was no tumor recurrence and spinal instability. Conclusion The internal and external communication tumors of the cervical spine should be selected according to the appropriate surgical approach. Microscopically, the tumor can be completely cut in one stage. If necessary, the corresponding vertebral reconstruction and spinal internal fixation should be performed to maintain the stability of the spine.