后路椎板切除、椎弓根内固定治疗上颈椎哑铃形肿瘤

目的探讨后路椎板切除、椎弓根内固定治疗上颈椎哑铃形肿瘤的方法和疗效。方法对15例PUTHⅠ、Ⅱ、Ⅲ、Ⅴ型上颈椎哑铃形肿瘤患者行后路椎板切除摘除肿瘤,同时行椎弓根内固定植骨融合术。结果患者均获得随访,时间2个月~5年。术后神经功能Frankel分级:9例D级恢复至E级,3例C级恢复至D级,1例C级、1例D级及1例E级术后无改变。术后3例出现脑脊液漏,2例行腰大池引流、1例抬高床尾引流后好转;2例出现单侧肢体肌力减弱,1例出现霍纳综合征,均经康复治疗后好转。1例复发,行二次手术治疗。13例疼痛较术前有明显改善或消失,2例无明显变化。结论后路椎板切除暴露摘除肿瘤,同时行椎弓根内固定植骨融合术治疗PUTHⅠ、Ⅱ、Ⅲ、Ⅴ型上颈椎哑铃形肿瘤,可彻底切除肿瘤病灶,解除颈脊髓及神经根压迫,重建上颈椎稳定性。

Posterior lamina resection and pedicle screw fixation for the treatment of upper cervical dumbbell tumors

Objective To explore the method and effect of posterior lamina resection and pedicle screw fixation in the treatment of upper cervical spinal canal dumbbell tumor. Methods Fifteen cases of PUTH typeⅠ,Ⅱ,Ⅲ,Ⅴcervi-cal spinal dumbbell shaped tumor patients underwent posterior laminectomy and removal of tumor, pedicle fixation and fusion. Results All patients were followed up for 2 ~60 months. Postoperative neurological function Frankel classification:9 cases of D recovered to grade E, 3 patients with grade C recovered to grade D, 1 grade C, 1 grade D and 1 grade E did not change. Postoperative cerebrospinal fluid leakage occurred in 3 cases, 2 cases underwent lum-bar cistern drainage;1 case was improved after the bed tail drainage;2 cases of unilateral limb muscle weakness, 1 case of Horner syndrome, they were improved after rehabilitation treatment. One case of recurrence underwent two times of surgical treatment. The pain of 13 patients was significantly improved or disappeared, and 2 patients had no significant changes. Conclusions Posterior laminectomy provides good exposure for removal of tumor, pedicle fixa-tion and bone grafting for the treatment of PUTH typeⅠ,Ⅱ,Ⅲ,Ⅴof upper cervical dumbbell shaped tumor, through which tumor lesions can be completely removed, cervical spinal cord and nerve root can be decompressed, and cervi-cal stability is reconstructed.