改良远外侧入路治疗高颈段椎管内外病变
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摘要
目的总结改良远外侧入路治疗高颈段椎管内外病变的手术情况和并发症,以供参考。方法回顾性分析本院2016年1月～2018年10月经改良远外侧入路手术治疗高颈段椎管内外病变18例的临床资料。结果该入路术中所见,视野显露清晰、全面,既可充分显露颅颈交界区、高颈段脊髓腹侧病变,也可充分显露椎管内外沟通性肿瘤,所有肿瘤在显微镜下一次手术全切除。该入路对骨质的破坏较小;该组患者均保留了相应节段椎体的后正中张力带;关闭椎管过程中,将切开的肌肉对应缝合到相应的附着点,并消灭死腔,基本达到原态复位。该入路对脊柱的静态及动态稳定性影响较小,所有患者未行脊柱内固定手术。术后2例出现术区皮下积液,经腰大池穿刺外引流后皮下积液消失痊愈出院,无手术死亡病例,无颅内感染病例。末次随访时(随访期限2～34月),18例患者均恢复良好(Karnofsky评分80分以上),无不良预后,未发现有颈椎失稳的情况发生。结论改良的远外侧入路治疗高颈段椎管内外病变,具有良好的术区视野暴露,较低的并发症发生率;随访发现该入路对颈椎稳定性破坏不大。
Objective To summarize the surgical procedures and complications of a modified Farlateral approach for treatment of upper cervical spinal canal lesions. Methods The clinical data of 18 patients with upper cervical spinal canal lesions treated by modified Far-lateral approach were retrospectively analyzed from January 2016 to October 2018 in our hospital. Results As seen in the approach, the visual field was clear and comprehensive, which could fully reveal the ventral lesions of the cranial-cervical junction and upper cervical spinal cord, and also fully reveal the communicating tumors of vertebral canal. All tumors were completely resected under the microscope. The approach inflicted less damage to the bone. In all patients in the group, the posterior median tension band of the corresponding segmental vertebral body was retained.During the process of closing the vertebral canal, the incision muscle was sutured to the corresponding attachment. This approach had mild impact on the static and dynamic stability of the spine. No internal fixation of spine was done to the patients. Two cases of subcutaneous effusion occurred after operations. There were no cases of operative death or intracranial infection. At the last follow-up, 18 patients recovered well(Karnofsky scores were above 80) without occurrence of adverse prognosis and cervical instability.Conclusion The modified Far-lateral approach for the treatment of upper cervical spinal canal lesions has a good visual field exposure with low incidence of surgery-related complications. According to the current follow-up, the approach causes little damage to cervical stability.
Objective To summarize the surgical procedures and complications of a modified Farlateral approach for treatment of upper cervical spinal canal lesions. Methods The clinical data of 18 patients with upper cervical spinal canal lesions treated by modified Far-lateral approach were retrospectively analyzed from January 2016 to October 2018 in our hospital. Results As seen in the approach, the visual field was clear and comprehensive, which could fully reveal the ventral lesions of the cranial-cervical junction and upper cervical spinal cord, and also fully reveal the communicating tumors of vertebral canal. All tumors were completely resected under the microscope. The approach inflicted less damage to the bone. In all patients in the group, the posterior median tension band of the corresponding segmental vertebral body was retained.During the process of closing the vertebral canal, the incision muscle was sutured to the corresponding attachment. This approach had mild impact on the static and dynamic stability of the spine. No internal fixation of spine was done to the patients. Two cases of subcutaneous effusion occurred after operations. There were no cases of operative death or intracranial infection. At the last follow-up, 18 patients recovered well(Karnofsky scores were above 80) without occurrence of adverse prognosis and cervical instability.Conclusion The modified Far-lateral approach for the treatment of upper cervical spinal canal lesions has a good visual field exposure with low incidence of surgery-related complications. According to the current follow-up, the approach causes little damage to cervical stability.
引文
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[17]杨诚,马峻明,杨墨松,等.上颈椎椎管内外哑铃形肿瘤的临床特点及外科治疗[J].脊柱外科杂志,2008,6(4):203-205.
[2]Schellinger KA,Propp JM,Villano JL,et al.Descriptive epidemiology of primary spinal cord tumors[J].J Neurooncol,2008,87(2):173-179.
[3]Jinnai T,Koyama T.Clinical characteristics of spinal nerve sheath tumors:analysis of 149 cases[J].Neurosurgery,2005,56(3):510-515.
[4]Ya?argil MG,Pait TG.Exposure versus Instability[J].J Neurosurg,1996,84(5):891-892.
[5]谢天浩,骆纯,马廉亭.颈椎椎管内肿瘤切除术中全椎板切除致颈椎畸形的危险因素及防治措施[J].中国临床神经外科杂志,2017,22(1):58-60.
[6]刘亚军,王金龙,郭运发,等.高颈段椎管内肿瘤的显微手术治疗[J].中国临床神经外科杂志,2017,35(12):804-807.
[7]沈林,范益民,刘晓东.椎管内肿瘤与脊柱稳定性[J].中华神经创伤外科电子杂志,2017,3(6):369-372.
[8]陈海锋,李丹,王跃龙,等.颈椎哑铃型肿瘤的临床分型及手术人路的选择[J].中华医学杂志,2014,94(19):1444-1447.
[9]闫亮,郝定均,杨小彬,等.上颈椎哑铃形椎管内神经鞘瘤的外科治疗[J].脊柱外科杂志,2018,16(2):24-27.
[10]陈永杰,陈赞,吴浩,等.椎管内外沟通肿瘤手术中脊柱稳定性的重建[J].中华神经外科杂志,2013,29(9):880-883.
[11]车晓明.椎管内肿瘤与脊柱稳定性[J].中国现代神经疾病杂志,2016,16(3):113-117.
[12]Molinari R,Bessette M,Raich AL,et al.Vertebral artery anomaly and injury in spinal surgery[J].Evid Based Spine Care J,2014,5(1):16-27.
[13]谭明生,董亮.对上颈椎损伤治疗原则的探讨[J].中国脊柱脊髓杂志,2013,23(5):387-388.
[14]田学丰,冯春国,王先祥,等.脊柱内固定技术在切除多节段椎管内肿瘤中的应用(附12例报道)[J].中国临床神经外科杂志,2016,21(11):673-675.
[15]昌耘冰,徐达传,尹庆水.颈椎生物力学模型的应用及进展[J].中国临床解剖学杂志,2003,21(2):187-189.
[16]Hirabayashi K,Miyakawa J,Satomi K,et al.Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament[J].Spine,1981,6(4):354-364.
[17]杨诚,马峻明,杨墨松,等.上颈椎椎管内外哑铃形肿瘤的临床特点及外科治疗[J].脊柱外科杂志,2008,6(4):203-205.