后正中入路显微治疗椎管内肿瘤24例

【摘要】目的：探讨后正中入路显微治疗椎管内肿瘤的随访结果和手术体会。方法：回顾性分析2016年-2018年间采取后正中入路显微治疗椎管内肿瘤24例，包括颈椎4例，胸椎11例，腰椎7例，胸腰椎2例。其中髓外硬膜下肿瘤21例，髓内肿瘤3例。术前McCormick脊髓功能评分Ⅰ级7例，Ⅱ级12例，Ⅲ级3例，Ⅳ级2例，根据肿瘤生长特点采用11例半椎板入路和13例全椎板入路手术。术中借助电生理监测皮质脊髓束电位变化，所有肿瘤均在显微镜下切除。结果：术后全切除21例，其中髓外19例，髓内2例，次全切除3例，髓外2例，髓内1例。24例患者症状术后均得到不同程度缓解。1例髓外肿瘤随访1年余复发予以再次手术切除。结论：后正中入路切除椎管内肿瘤，正确的显微切除技巧，合适的椎板暴露，电生理监测，必要时椎弓根内固定等方法有助于提高术中脊髓和神经根功能的保护，维持术后脊柱稳定性，是保证手术疗效的关键因素。

Posterior midline approach treatment for 24 patients with intraspinal tumors

【Abstract】Objective: To investigate the follow-up outcomes and operational experience of posterior midline approach treatment for patients with tumor in spinal canal．Methods: A total of 24 cases with tumor in spinal canal from January 2016 to December 2018 in our hospital were studied retrospectively, including 4 tumors located in cervical spine, 11 tumors in thoracic spine, 7 tumors in lumbar spine, and 2 tumors in thoracolumbar spine. These are also 21 cases of intradural extramedullary tumor and 3 cases of intramedullary tumor. According to the McCormick scores，there were 7 cases of grade Ⅰ，12 cases of grade Ⅱ，3 cases of grade Ⅲ，and 2 cases of grade Ⅳ preoperatively．The operation was performed by opening through the back entry or removing half (11 cases) or whole lamina (13 cases) of vertebral arch based on the characteristics of tumor growing. Using electrophysiological monitoring to record potential changes of corticospinal tract in intraoperative period. All tumors were resected under microscopy. Results: There were 21 cases of total tumor resection including 19 cases of intradural extramedullary tumor and 2 cases of intramedullary tumor, and 3 cases of subtotal tumor resection, with 2 intradural extramedullary tumors and 1 intramedullary tumor. These 24 patients received the varying degree alleviating postoperatively. One intradural extramedullary tumor was resected because of recurrence after 1 year. Conclusion: The posterior midline approach treatment for intraspinal canal tumor is effective. It is benefit for protecting intraoperative spinal cord and nerve root function during operation, maintaining spinal stability postoperatively, and reducing occurrence of spinal deformity and scar adhesion postoperatively, with choosing the right laminectomy, electrophysiological monitoring, pedicle internal fixation if necessary and so on. Meanwhile correct skilled microsurgery resection is the key factor for assuring good prognosis of operation.