显微手术治疗椎管肿瘤145例临床分析

目的 探讨椎管肿瘤的显微手术治疗方法，分析临床治疗椎管肿瘤的相关策略。方法 回顾性分析我院神经外科2014年12月至2016年11月收治的145例椎管肿瘤手术患者的临床资料。患者分别选择半椎板、全椎板或椎板关节突开窗方式行显微镜下肿瘤切除术，其中52例患者行脊柱内固定术。术后随访3～26个月，所有患者均复查X线片和磁共振成像，内固定患者加做计算机断层扫描；分别于术前、术后1周、术后3个月时，采用McCormick分级评估脊髓功能。结果 145例患者中，127例行肿瘤全切除术，16例行近全切除术，2例行部分切除术。1例颈髓内肿瘤患者术后出现颈椎后凸畸形，行再次矫形手术；52例行脊柱内固定术的患者术后均无钉棒脱位、脊柱不稳现象。术后1周、术后3个月时，McCormick分级均优于术前（P<0.05）。结论 显微手术是治疗椎管肿瘤的有效手段，良好的术中暴露、可靠的脊柱内固定对于减少椎管肿瘤术后的并发症至关重要。

Microsurgery for spinal canal tumors: a clinical analysis of 145 cases

Objective To explore the microsurgical treatment of spinal canal tumors and to analyze the strategies for clinical treatment of spinal canal tumors. Methods Were retrospectively analyzed the clinical data of 145 patients with spinal canal tumors who were treated in our hospital from Dec. 2014 to Nov. 2016. Microscopic resection of tumors was performed with half lamina-, full lamina-, or lamina joint-fenestration. Spinal internal fixation was performed in 52 patients. The patients were followed up for 3-26 months. X-ray and magnetic resonance imaging were performed again in all patients, and computed tomographyed was performed in patients undergoing internal fixation. The spinal cord function was assessed by McCormick grade before operation, 1 week after operation and 3 months after operation. Results Of the 145 patients, 127 underwent total resection, 16 underwent subtotal resection and 2 underwent partial resection. One patient with cervical intramedullary tumors developed kyphosis after operation and underwent reoperation. No screw rod dislocation or spine instability was found in the 52 patients undergoing spinal internal fixation. The McCormick grading was significantly better 1 week and 3 months after operation versus before operation (P<0.05). Conclusion Microsurgery is an effective method for treatment of spinal canal tumors. Good intraoperative exposure and reliable spinal internal fixation are essential to reduce the complications after spinal canal tumor surgery.