单开门椎管成形治疗儿童颈胸段椎管内髓外肿瘤

目的 探讨单开门椎管成形、重建椎管后部结构治疗儿童颈胸段椎管内髓外良性肿瘤的可行性及临床疗效.方法 1998年5月至2012年5月,应用单开门掀起椎板、显微切除椎管内髓外肿瘤、椎板棘突复合体原位复位重建椎管后部结构的方法治疗儿童颈胸段椎管内髓外肿瘤28例.男17例,女11例;年龄1岁8个月～13岁,平均8.2岁;病程3个月～2年.影像学显示:肿瘤长度0.8～4 cm,占据1.5～4个脊髓节段.肿物偏向左侧12例,右侧10例,居中6例.结果 随访12个月～5年,平均32个月.手术部位颈段19例、胸段9例,椎板开门数2～5个,平均2.5个.平均手术时间86 min (75～146 min),术中平均失血128ml(85～356ml).所有病例均行X线片检查,未见脊柱侧凸、后凸畸形及失稳征象,23例复查CT显示复位的椎板棘突复合体无内陷、移位,28例复查MRI见椎管内肿瘤无复发,无椎管狭窄、黄韧带和硬脊膜增厚.脊柱曲度的变化:颈椎病例中颈椎曲度由术前的(17.8±8.4)°减少为术后12个月时的(16.1±7.8)°,手术前后比较无统计学差异(P＞0.05);胸椎病例局部Cobb角由术前的(11.6±3.8)°增加至术后12个月时的(12.5±4.6)°,手术前后比较无统计学差异(P＞0.05).结论 单开门稚管成形、重建椎管后部结构治疗儿童颈胸段椎管内髓外肿瘤,对椎管内髓外肿瘤的暴露及切除效果满意的同时,保存了一侧椎板的连续性,椎板棘突韧带复合体复位后恢复了脊柱的原有解剖结构,对脊柱的稳定性影响小,可避免术后儿童发育过程中脊柱畸形的发生.

Treatment of pediatric intraspinal extramedullary tumors with open-door laminoplasty in cervicothoracic segment

Objective To explore the feasibility and clinical efficacy of open-door laminoplasly and reconstruction of spinal posterior structure for cervicothoracic intraspinal extramedullary tumors in children.Methods From May 1998 to May 2015,open-door laminoplasty and reconstructing posterior spinal structure were employed for 28 cases of cervicothoracic intraspinal extramedullary tumors.There were 17 boys and 11 girls with a mean age of 8.2 (5/3-13) years.And the duration of disease was 3 months to 2 years.Imaging:tumor length of 0.8-4 crn accounting for 1.5 to 4 spinal cord segments.The deviations were left (n=12),right (n=10) and central (n=6).Results The average follow-up period was 32 (12-60) months.And the operative sites were cervical (n =19) and thoracic (n =9).The average opening number was 2.5 (2-5),average operative duration 86(75-146) min and average volume of blood loss 128 (85-356) ml.Postoperative radiography showed no sign of scoliosis,kyphosis or instability.On computed tomography,it showed that shift of lamina and spinous process complex reduction had no depression (n =23).And on magnetic resonance imaging,28 cases had no recurrence,intraspinal tumor,spinal stenosis or thickening of yellow ligament and dura.Cervical curvature changed from (17.8 ± 8.4) to (16.1 ± 7.8) at 12 months.No significant difference existed between pre-and post-operation (P＞0.05).Local Cobb angle of thoracic spine changed from (11.6 ± 3.8) to (12.5 ± 4.6) at 12 months.No significant difference existed between pre-and post-operation (P＞0.05).Conclusions For cervical thoracic intraspinal extramedullary tumors in children,single open-door laminoplasty and reconstruction of spinal posterior structure offers satisfactory exposure and tumor resection and preserves laminal continuity.After reduction of vertebral column,original anatomical spinal structure of spine is restored.With little impact on spinal stability,it avoids the occurrence of spinal development deformity in children.