胸腰段椎管内病变诊断与治疗

目的探讨胸腰段椎管内病变的磁共振成像(MR I)诊断和治疗。方法1998年10月~2005年5月,共收治胸腰段椎管内病变患者31例,其中男性14例,女性17例,平均年龄48.2岁(38~71岁)。所有患者术前均行MR I平扫,必要时行增强扫描;根据术前对病变性质的判断以及术中具体情况,采取不同的手术方式。通过Frankle标准评价脊髓功能恢复情况。结果髓外硬膜下肿瘤21例,硬膜外肿瘤4例,髓内肿瘤1例,椎管内、外及硬膜内哑铃型肿瘤3例,其他椎管内病变2例;其中第10~12胸椎19例,第1~3腰椎12例。术中分别给予切除或大部切除。术后所有患者神经功能恢复情况(Frankle)评分较术前均有不同程度提高。结论MR I是诊断椎管内病变的首选检查方法,定性仍有一定困难。术中疑为恶性者,快速冰冻病理组织学检查。良性病变尽量全切,恶性肿瘤无法切除,也应行脊髓减压。

Diagnosis and treatment of intraspinal lesions in thoracolumbar spine

Objective To investigate the diagnosis by MRI and treatment of intraspinal lesions in the thoracolumbar spine.Methods From October 1998 to May 2005,31 patients with thoracolumbar intraspinal lesions who underwent surgery were reviewed.There were 14 males and 17 females,with an average age of(48.2) years old(range,38 to 71).All patients received preoperative regular MRI examinations,enhanced MRI also was performed if needed.Different types of surgeries were performed based on the preoperative anticipated nature of the intraspinal lesions and intraoperative findings.Frankle grading system was used to assess the spinal cord function.Results There were intradural extramedullary tumors in 21 cases,extradural tumors in 4 cases,intramedullary tumor in 1 case,dumbbell tumors in 3 cases and other lesions in 2 cases.Ninteen lesions were between T_(10) and T_(12) and the remaining were between L_1 and L_3.Total or subtotal resection were achieved for all the lesions.At least one Frankle grade improvement were obtained for all patients.Conclusion MRI should be the first radiographic option for the diagnosis of intraspinal lesions,though it can not definitively determine the nature.Suspected malignant lesions can be confirmed by intraoperative frozen pathological examination.Total removal should be performed for benign lesions;for irresectable malignant tumors,decompressive resection should be done.