临床外科杂志 ›› 2018, Vol. 26 ›› Issue (10): 783-786.doi: 10.3969/j.issn.10056483.2018.10.020

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后路椎板切除手术治疗脊柱椎管内神经鞘瘤的疗效分析

  

  1. 430060  武汉大学人民医院脊柱外科
  • 出版日期:2018-10-20 发布日期:2018-10-20

Clinical analysis of posterior laminectomy in the treatment of intraspinal neurilemmoma

  1. Department of Spinal Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China 
  • Online:2018-10-20 Published:2018-10-20

摘要: 目的  探讨后路椎板切除手术治疗脊柱椎管内神经鞘瘤的临床疗效。方法  35例椎管内神经鞘瘤患者,颈段6例,胸段10例,腰骶段19例。4例位于脊髓髓内,21例位于髓外硬膜下,10例位于硬膜外,其中呈哑铃状8例。均行后路椎板切除手术治疗,其中9例肿瘤及带瘤神经根因不能分离或神经根变形坏死而一并切除,28例采用脊柱椎弓根或侧块内固定。术后随访观察临床疗效,复查X线和CT观察脊柱稳定性及植骨融合情况,复查MRI平扫+增强观察肿瘤有无复发。结果 35例患者肿瘤均被完整切除,术后病理结果证实均为神经鞘瘤。手术时间2~6小时,平均3.6小时。术中出血量300~900ml,平均450ml。术后1例麻醉清醒后24小时内出现双下肢感觉、运动功能障碍,MRI未见明显血肿及脊髓压迫,考虑脊髓缺血再灌注损伤,及时予大剂量甲强龙激素冲击及脱水、营养神经治疗,症状明显改善。术后21例患者出现了不同程度的脑脊液漏。术后随访时间3~34个月,平均18.2个月,所有患者的临床症状和神经功能均有明显改善,肿瘤无复发。随访期间,所有采用脊柱内固定术患者均未见椎体不稳的表现。结论  后路椎板切除手术能有效治疗脊柱椎管内神经鞘瘤,结合显微镜技术能够更好地暴露及完全切除肿瘤,采用此方法治疗脊柱椎管内神经鞘瘤疗效满意。

Abstract: Objective   To evaluate the clinical efficacy of posterior laminectomy in the treatment of intraspinal neurilemmoma. Methods  A total of 35 cases with intraspinal neurilemmoma was reviewed retrospectively in retrospective study.Of all cases,6 cases had defect in cervical spine,10 in thoracic,19 in lumbar of sacral.4 cases had dfect in intramedullary,21 in intradural extramedullary,10 cases in epidural and 8 cases were dumbbell shaped.All patients were treated with posterior laminectomy,of which 9 cases of nerve roots which can not be separated from the tumor were removed.Internal fixation was performed in 28 cases.Patients were followed up for the clinical effects.Xray and CT were performed to observe spinal stability and bone graft fusion.MRI were performed to observe the tumor recurrence. Results The tumors of  all 35 patients were completely resected,and all of them were neurilemmomas agter pathological examination.The operation time was 2~6 h,with an average of 3.6 h,and blood loss was 300~900 ml,with an average of 450 ml.After  the operation,1 case had sensory and motor dysfunction in the lower extremities,no obvious hematoma and spinal cord compression in MRI.The spinal cord ischemia reperfusion injury was considerd,and large dose of methylprednisolone was given in time,and the treatment of dehydration and nutrition nerve was given.The symptoms were improved obviously.The CSF leakage was found in 21 patients.The followup time was 3~34 months,with an average of 18.2 months.All the patients showed significant improvement in clinical symptoms and neurological function,and no recurrence occurred.No sponndylolisthesis and instability phenomena were observed in all 35 patients. Conclusion Posterior laminectomy can be effective in the  treatment of intraspinal neurilemmoma and can be better exposed and completely resected with microscope technique.

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