论文-脊柱内固定技术在切除多节段椎管内肿瘤中的应用+(附12例的报告)0.doc

脊柱内固定技术在切除多节段椎管内肿瘤 (附12例报告) [摘要] 目的 探讨在脊柱内固定技术在切除多节段（3个或3个节段以上）椎管内肿瘤时，保护神经功能、重建脊柱稳定性的作用和方法。方法 回顾性分析我科2015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患者的临床资料。其中髓内肿瘤8例，髓外硬膜下2例，硬脊膜外肿瘤2例。手术在显微镜下操作，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，维持脊柱的稳定性。结果 术后病理：髓内室管膜瘤5例，脂肪瘤2例，星形胶质瘤1例，脊膜瘤2例，硬膜外血管畸形伴出血2例。5例室管膜瘤全切除，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、血管损伤病例。术后无感染病例。术后2周，9例术前下肢肌力下降的病例，术后明显好转，2例脂肪瘤患者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，提示内固定置入物基本符合要求。近期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。 【关键词】椎管肿瘤；显微外科手术；脊柱内固定 Microneurosurgery and spine instrumentation for multilevel spinal tumor (report of 12 cases) Abstract :Objective To discuss the way to protect nerves function and spinal stability in the operation of resecting the multilevel spinal tumor. Methods Clinical datas of 12 patients who suffer from multilevel spinal tumors were analyzed retrospectively.Intramedullary lesion in 8 cases , subdural extramedullary lesion in 2 cases and epidural lesion in 2 case. All cases were resected by microsurgical technique and somatosensory evoked potential technology to protect the spinal cord function;Spinal instrumentation ,such as ?pedical screw fixation and lateral mass fixation,were used to maintain the stability of the spine. Result Pathological analysis： ependymoma 5 cases; lipoma 2 cases;Meningioma 2 cases, two epidural lesion is vascular malformations. Astrocytoma 1 case. Tumors were totally removed in 8 cases(66．7％)，2 cases (16．7％) of lipoma and 1 case of astrocytoma were subtotally removed．Nerve and main vessel were not damaged during instrumentation .There was no infection and death case. Neurological function were improved in 9 cases 2 weeks after operation;Two cases of lipoma feel pain in lower limb ,but muscle strength was not changed. Follow up 1～8 monthes, Implantations were not moved or fractured .Conclusions．Microsurgical technique combined with somatosensory evoked poten