椎管内硬膜下肿瘤经半椎板入路切除的方法研究

目的:探讨经半椎板切除入路行椎管内硬膜下肿瘤切除术的可行性及疗效。方法:1999年10月～2008年7月共手术治疗86例颈、胸、腰椎管内硬膜下肿瘤患者,均在偏肿瘤侧对应肿瘤节段切除半侧椎板、棘突根部、关节突内1/3,切开硬膜,游离并切除肿瘤。结果:86例肿瘤均获得顺利切除,手术时间45～70分钟,平均54分钟;出血量80～120ml,平均90ml。3例患者术后出现脑脊液漏,每日切口旁局部穿刺抽出漏出液,并采取头低脚高位,术后3周愈合。61例获得4个月～8年1个月,平均3年5个月随访,无颈、胸、腰痛等症状,获得随访的42例术前不完全性瘫痪患者肌力由术前3～4级恢复至术后5级。结论:位于椎管内脊髓背侧、腹侧及突入椎间孔的硬膜下肿瘤,采用半椎板切除入路可顺利切肿瘤组,该方法出血少,创伤小,可最大限度地保护脊柱的稳定性。

Spinal Subdural Approach for Tumor Resection Hemilaminectomy Research

Objective:To evaluate the half-line approach laminectomy spinal subdural feasibility of tumor resection and efficacy. Methods:A total of 86 cases of surgical treatment of cervical,thoracic and lumbar spinal subdural tumors in patients with partial tumor side were segmental resection of the tumor corresponding hemi lamina,spinous process root,the facet 1/3,cut the dura mater,free and remove the tumor from October 1999～July 2008.Results:86 patients had received successful tumor resection,operative time 45～70min,an average of 54min;blood loss was 80～120ml,an average of 90ml.3 cases of postoperative cerebrospinal fluid leakage,incision daily leak fluid out of the side puncture,and tooke the Trendelenburg position,after 3 weeks of healing.61 patients were followed up from 4 months to 8 years and 1 month(average of 3 years 5 months),no neck,chest,back pain and other symptoms,42 patients were followed with a preoperative muscle strength in patients with incomplete paralysis from reoperative 3 recovery after 4 to 5.Conclusion:The spinal cord in the dorsal,ventral,and broke into the intervertebral foramen subdural tumor semi laminectomy approach could be successfully cut the tumor,the method less blood loss,trauma and spine for maximum protection stability.