经椎旁肌间隙入路治疗胸腰椎椎间孔哑铃形肿瘤

目的 探讨经椎旁肌间隙入路切除胸腰椎椎间孔哑铃形肿瘤的手术方法和效果。方法2003年1月至2009年6月共收集胸腰段哑铃形肿瘤患者32例：神经鞘瘤23例，神经纤维瘤6例，神经纤维瘤病3例。手术采用胸腰椎后路经椎旁肌间隙入路，术中分离多裂肌和最长肌间隙，切除关节突关节后，暴露椎间孔内外的肿瘤，完整切除肿瘤。必要时可经椎弓根螺钉内固定和脊柱植骨融合术重建脊柱稳定性。所有患者获得随访。结果 所有肿瘤均全切除，其中23例行内固定重建脊柱稳定性。神经功能均有改善。术后随访8个月至6年，平均32个月。无内固定松动、断裂，无脊柱后凸、侧凸等畸形。结论 以椎间孔及椎间孔外部分为主的腰椎椎间孔哑铃形肿瘤，可采用经椎旁肌间隙入路椎间孔切开切除，必要时用椎弓根螺钉固定、椎间植骨融合，重建脊柱稳定性。此方法具有肿瘤暴露好、术中出血少、术后可早期下床活动、兼顾脊柱稳定性等优点。

Resection of the dumbbell tumor at the thoracolumbar spine through the paraspinal muscle approach combined with the TLIF technique

Objective To study the resection of the dumbbell tumor at the thoracolumbar spine through a paraspinal muscle approach combined with the facetomy if nesseary. Method From Jan 2003 to Jun 2009,32 cases with dumbbell tumor were enrolled and operated on. Of 32 cases, 23 cases were schwannoma, 6 cases were neurofibroma, and 3 cases were neurofibromatosis. A paraspinal approach at the interval between the longissimus and multifidis muscle was used to resect the dumbbell tumor in the foramina and passing through and out of the foramina. If necessary, the spine was reconstructed with the TLIF technique after facetomy. Results 32 cases were followed up for a mean of 32 months ( range: 8 months to 6 years). The tumors were removed thoroughly. Among 32 cases, 23 cases underwent instrumentation for reconstruction of the spine. No loosening, breakage of the implant occurred and no spinal deformity was found. ConclusionsThe dumbbell tumor at the thoracolumbar spine, with predominant foraminal extensions or anterior paraspinal tumors, could be resected directly through the paraspinal muscle approach. After facetomy,the total of tumor could be exposed and removed. The spine can be reconstructed with fusions after facetomy. The approach is less invasive and has the advantage with good operative exposure, less intraoperative bleeding,early ambulation and spinal stability.