【摘要】 目的探讨微通道辅助经椎旁肌间隙入路(Wiltse入路)显微手术切除胸腰椎椎旁肿瘤的效果。方法回顾性分析2017年2月～2020年3月12例胸腰椎椎旁肿瘤的临床资料,包括腰椎椎旁肿瘤8例,胸椎椎旁肿瘤4例。肿瘤长径1.5～3.5 cm,平均2.3 cm。临床症状包括相应神经支配区疼痛10例,感觉障碍(麻木)6例,下肢肢体无力1例。采用微通道辅助下椎旁肌间隙入路,显微手术切除肿瘤。结果 12例肿瘤均获全切除。手术时间60～100 min,平均78.5 min;术后住院时间4～7 d,平均5.3 d。术后病理均为神经鞘瘤。术后无感染,无死亡。均无明显腰背部疼痛。1例节段性感觉减退,6个月恢复正常;其余患者无神经功能障碍加重。术后随访3～36个月,中位数19.5月,未见脊柱畸形,未见肿瘤复发或残留。结论微通道辅助经椎旁肌间隙入路显微手术切除胸腰椎椎旁肿瘤有利于避免多裂肌附着点和小关节的破坏,保护多裂肌及其供应血管和支配神经,有利于保持胸腰椎稳定性,避免术后慢性腰痛的发生。更多还原

【Abstract】 Objective To explore the effect of microchannel assisted paravertebral sacrospinalis splitting approach(Wiltse approach) in the treatment of thoracolumbar paravertebral tumors. Methods The clinical features, imaging characteristics and surgical methods of 12 cases of thoracolumbar paravertebral tumors from February 2017 to March 2020 were reviewed and analyzed. There were 8 cases of lumbar paravertebral tumors and 4 cases of thoracic paravertebral tumors. The long diameter of the tumor was 1.5-3.5 cm(mean,2.3 cm).The clinical symptoms included pain in the corresponding innervation area in 10 cases, sensory disturbance(numbness) in 6 cases, and limb weakness in 1 case. The tumor was resected by microsurgery with microchannel assisted paravertebral sacrospinalis splitting approach. Results All the 12 tumors were totally resected. The operation time was 60-110 minutes, with an average of 78.5 minutes. The postoperative hospital stay was 4-7 days, with an average of 5.3 days. The postoperative pathology was schwannomas in all cases. There was no infection, death or obvious back pain. Postoperatively, one patient had segmental hypoesthesia who returned to normal after 6 months, and the rest of patients had no aggravation of neurological dysfunction. The follow-up period ranged from 3 to 36 months with a median of 19.5 months. No spinal deformity was found, and no recurrence or residual tumors were found. Conclusion Microsurgery of thoracolumbar paravertebral tumor via paravertebral sacrospinalis splitting approach assisted by microchannel is beneficial to avoid the destruction of the attachment of the multifidus and small joints, to protect the multifidus and its supply vessels and nerves, to maintain the stability of the thoracolumbar spine, and to avoid the occurrence of chronic low back pain.更多还原