【摘要】 目的探讨脊柱内固定技术在切除多节段(3个或3个节段以上)椎管内肿瘤中的作用。方法回顾性分析2014年1月至2016年1月采用脊柱内固定技术结合显微神经外科手术治疗12例多节段椎管内肿瘤的临床资料。在显微镜下手术,应用体感诱发电位监测脊髓神经功能,在切除肿瘤的同时行椎弓根或侧块(颈段)钉棒内固定技术重建脊柱后柱。结果 5例室管膜瘤、2例脊膜瘤和2例硬膜外血管畸形均全切除,2例脂肪瘤大部切除,1例星形胶质细胞瘤部分切除;内固定时无神经、脊髓、血管损伤。术后无感染。9例术前有下肢肌力下降,术后2周明显好转;2例脂肪瘤术后出现下肢疼痛和麻木,但未出现肌力下降加重。术后X线检查示,内固定置入物基本符合要求。术后随访无固定装置断裂、移位病例。结论脊柱内固定联合显微神经外科技术是在切除多节段椎管内肿瘤的同时、维护脊柱稳定性并巩固手术治疗效果的重要措施。更多还原

【Abstract】 Objective To discuss the way to protect neurological function and spinal stability in the microsurgery for themultilevel spinal tumors.Methods The clinical data of 12 patients with multilevel spinal tumors, of whom, 8 had intramedullary tumors,2 spinal subdural extramedullary and 2 epidural, were analyzed retrospectively. All the patients underwent microsurgery for the spinaltumors and intraspinal internal fixation including pedical screw fixation and lateral mass fixation for maintaining the stability of thespinal column under monitoring of somatosensory evoked potential from January, 2014 to January, 2016.Results The post operativepathological examination showed that of 12 spinal lesions, 5 were ependymomas, 2 lipomas, 2 meningiomas, 2 vascular malformationsand 1 astrocytoma. The lesions were totally removed in 9 patients(81.8%) and subtotally in 3 patients including 2 patients with lipomasand 1 patient with astrocytoma. The nerve and main vessel were not damaged during the operation. There was no infection in all thepatients. The neurological function was improved in 9 patients 2 weeks after the operation. There were pain in lower limbs, but musclestrength was not changed after the operation in 2 patients with lipomas. Following up from 1 to 10 months showed that the implantationgrafts were not moved or fractured in all the patients.Conclusions Microsurgical technique combined with somatosensory evokedpotential technology is beneficial to the total resection of the lesions and maintain of the neurological function in the patients withmultilevel spinal lesions.The intraspinal internal fixation is very important to protection of the spinal stability during microsurgery forthe multilevel spinal tumors.更多还原