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目的介绍棘突悬吊式颈椎管扩大成形肿瘤摘除术,评价其在治疗颈椎管内肿瘤中应用的效果。方法2003年7月~2006年6月,治疗26例颈椎管内肿瘤,其中男14例,女12例;年龄25~57岁,病程3~24个月。四肢肌力~级,四肢肌张力高,腱反射亢进,病理反射阳性,2例出现髌阵挛及踝阵挛。术前MRI检查示肿瘤大小1.5cm×0.8cm~2.8cm×2.0cm,位于C3-6节段,其中C3、4节段8例,C4、5节段9例,C5、6节段9例。术前摄颈椎动力位X线片,测量患者颈椎平均活动范围,前屈30~45°,平均39.3°;后伸32~45°,平均40.5°;左侧屈20~45°,平均25°;右侧屈30~45°,平均36.6°。术后观察症状体征的变化,摄动力位X线片,测量颈椎活动范围,其中15例患者复查MRI及CT。结果术后患者均获随访6~12个月,平均8个月。患者感觉、肌力、肌张力、反射均有不同程度恢复,无并发症及死亡发生,生活全部自理。术后10例出现颈部酸痛,功能锻炼后逐渐缓解。术后7周复查MRI及CT可见棘突与椎板间骨性愈合,未出现“关门”现象,后柱结构基本恢复。术后复查动力位X线片示无颈椎不稳、椎管狭窄,颈椎活动范围:前屈28~43°,平均37.9°;后伸32~44°,平均41°;左侧屈25~45°,平均23°;右侧屈35~45°,平均36.2°。结论棘突悬吊式颈椎管扩大成形术既可充分显露肿瘤,又可在悬吊固定后最大程度保留后柱结构,有效预防术后并发症的发生。
Objective To introduce the method of cervical spondyloplasty with spinous process and to evaluate its effect in the treatment of cervical spinal tumors. Methods From July 2003 to June 2006, 26 cases of cervical spinal canal tumors were treated, including 14 males and 12 females, aged from 25 to 57 years with a duration of 3 to 24 months. Limb muscle strength ~ grade, limb muscle tension, tendon hyperreflexia, pathological reflex positive, 2 cases of patellar clonus and ankle clonus. Preoperative MRI showed tumor size 1.5cm × 0.8cm ~ 2.8cm × 2.0cm, located in the C3-6 segment, including C3,4 segment 8 cases, C4,5 segment 9 cases, C5,6 segment 9 cases . Preoperative cervical spine dynamic X-ray film, measuring the average range of cervical activity, flexion 30 ~ 45 °, an average of 39.3 °; after stretching 32 ~ 45 °, an average of 40.5 °; left flexion 20 ~ 45 °, an average of 25 ° ; Right flexion 30 ~ 45 °, an average of 36.6 °. Postoperative observation of signs and symptoms, perturbation force X-ray films, measuring the scope of cervical activity, of which 15 patients reviewed MRI and CT. Results All patients were followed up for 6 to 12 months with an average of 8 months. Patients feel, muscle strength, muscle tone, reflex have different degrees of recovery, no complications and death, life all self-care. Ten cases showed neck ache after operation, gradually relieved after functional exercise. 7 weeks after MRI and CT examination, the bony union between the spinous process and the lamina was observed. The phenomenon of “closing the door” did not appear and the posterior column structure was basically recovered. Postoperative review of dynamic X-ray showed cervical instability, spinal stenosis, cervical activity range: 28 ~ 43 ° flexion, an average of 37.9 °; extension of 32 ~ 44 °, an average of 41 °; left flexion of 25 to 45 °, an average of 23 °; right flexor 35 ~ 45 °, an average of 36.2 °. Conclusions Spinal tuberosity cervical spondyloplasty can not only fully reveal the tumor, but also retain the posterior column structure after suspension fixation to prevent postoperative complications effectively.