症状性颈椎血管瘤合并脊髓型颈椎病的手术治疗

目的探讨治疗症状性颈椎血管瘤合并脊髓型颈椎病患者的手术方法及效果。方法 2006年1月-2008年9月收治18例症状性颈椎血管瘤合并脊髓型颈椎病患者,其中男10例,女8例;年龄30～62岁,平均45.3岁。病程10～26个月,平均15.6个月。所有患者均为单椎体血管瘤,其中C32例、C43例、C55例、C65例、C73例。X线片呈典型的"栅栏状"改变。颈椎血管瘤根据临床和影像学特点进行分型,Ⅱ型13例,Ⅳ型5例。先行颈前路椎间盘或椎体次全切除减压植骨钛板内固定术,后在C臂X线机指导下对血管瘤椎体行经皮椎体成形术(percutaneous vertebro plasty,PVP)。术后摄颈椎X线片观察骨水泥分布、内固定物存在情况,以日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)评定患者术后神经功能恢复及颈肩部疼痛缓解情况。结果所有患者均顺利完成手术,未发生脊髓及神经损伤,切口均愈合良好。术中2例发生骨水泥椎前渗漏,患者未出现不适症状。18例均获随访,随访时间24～28个月,平均26个月。患者症状均有不同程度改善,成形椎体无骨折、塌陷,血管瘤无复发,内固定物无松动、断裂和移位;术后3～4.5个月,平均4个月达骨性融合。术后3个月及末次随访时JOA评分及VAS评分均较术前明显改善(P<0.05);末次随访时根据JOA评分获优9例,良6例,可2例,差l例。结论前路减压植骨内固定加PVP是治疗症状性颈椎血管瘤合并脊髓型颈椎病的有效方法之一,在脊髓获得彻底减压的同时有效缓解了血管瘤引起的临床症状。

SURGICAL TREATMENT OF SYMPTOMATIC CERVICAL VERTEBRAL HEMANGIOMA ASSOCIATED WITH CERVICAL SPONDYLOTIC MYELOPATHY

Objective To investigate the treatment methods and the clinical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy.Methods A retrospective analysis was performed in 18 patients(10 males and 8 females,aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008.The disease duration was 10-26 months(mean,15.6 months).All patients had si...