手术切除治疗颈椎管内良性肿瘤的疗效观察

目的：探讨手术切除治疗颈椎管内良性肿瘤的方法及临床疗效。方法：回顾性分析自2001年至2005年经病理证实的颈椎管内良性肿瘤22例,男16例,女6例;年龄18～56岁,平均43.8岁。22例患者术前主要症状为颈部疼痛、四肢麻木无力、大小便失禁、锥体束征等。术前行X线、CT和MRI检查,诊为神经鞘瘤11例,神经纤维瘤4例,脊膜瘤3例,脂肪瘤和椎管内囊肿各2例。完全切除18例,切除60%以上3例,切除25%并取活检1例。11例Ⅰ期行颈椎稳定性重建。结果：22例均获得随访,时间6～84个月,平均12.5个月。复发并再手术2例。JOA评分：术前为（6.52±1.10）分,术后为（11.42±0.79）分,手术前后差异有统计学意义（t=35.38,P〈0.001）。手术改善率为（46.70±2.46）%,颈椎稳定性重建手术改善率为（62.37±3.58）%,其他手术方法的改善率（41.21±4.63）%。按JOA评定方法：优18例,良2例,中1例,差1例。结论：手术切除治疗颈椎管内良性肿瘤,术后复发率较低,肿瘤切除不全是复发的主要原因之一。MRI（MRA）是鉴别诊断、指导手术的有效影像学方法。

Surgical treatment and effect observation of cervical intraspinal benign neoplasms

Objective: To investigate the diagnosis,surgical procedure and clinical outcome of cervical intraspinal benign neoplasm. Methods: Twenty-two cases confirmed pathologically were reviewed included 16 males and 6 females with an average age of 43.8 years old ranging from 18 to 56 years. Symptoms mainly included neck pain,numbness and weakness of the extremities,urinary and fecal incontinence,pyramid signs,etc. All underwent X-ray,CT and MRI,11 cases were diagnosised as neurilemomas,4 neurofibromas,3 spinal meningiomas,2 intraspinal cysts and 2 lipomas. The tumors were removed completely in 18 cases,above 60% in 3 cases and 25% with biopsy in 1 case. Cervical stability in 11 cases was restored after removal of tumors. Results: All were followed-up for from 6 to 84 months(means 12.5 months). Symptoms improved in 20 cases and stable in 1 case and worsened in 1 case postoperatively according to JOA scoring system. Two patients recurred and were treated with second surgery. JOA scoring was(6.52±1.10) before operation,(11.42±0.79) after operation,there was statically significance (t=21.38,P<0.001). The average recover ratio of total was(46.7±2.46)%,cervical stability was(62.37±3.58)%,the other methods was(41.21±4.63)%. The results of JOA were excellent in 18 cases,good in 2,fair in 1 and poor in 1. Conclusion: The surgical exairesis for cervical intraspinal benign neoplasm has low post-operative recurrence. The main reason of recurrence is not removed the tumor completely. MRI is regarded the effective method which is helpful in differential diagnosis and surgery guidance.