2019NO.25China&ForeignMedicalTreatment中外医疗DOI院10.16662/j.cnki.1674-0742.2019.25.025腰椎管内骨性占位经皮脊柱内镜治疗分析王胜利袁张美菊袁张庆琳汶上县人民医院骨科袁山东济宁272501[摘要]目的探讨腰椎管内骨性占位经皮脊柱内镜显微手术疗效遥方法回顾性分析2017年1月要2019年2月该院神经外科15例腰椎管内骨性占位患者的临床资料遥肖氏改良分区分期院I期6例袁域期5例袁芋期3例袁郁期1例遥手术方式院后正中半椎板入路9例袁其中内固定2例曰后正中人路棘突椎板复合体原位回植椎管成形术3例曰颈前入路柱稳定情况袁采用Frankel分级标准评价患者的脊髓功能恢复情况遥结果该组15例患者均在显微镜下一期全部切除遥肿瘤性质院神经鞘瘤14例袁神经节细胞瘤1例遥术后无脑脊液漏及切口感染遥术后Frankel分级显示袁患者脊髓功能恢复D级4例袁E级11例遥随访1~24个月袁平均13个月袁无肿瘤复发及脊柱失稳遥结论颈椎椎管内外沟通性肿瘤应选择合适的手术入路袁显微镜下可一期全切肿瘤袁必要时行相应的椎体重建和脊柱内固定术以维持脊柱稳定性遥[关键词]腰椎管曰骨性占位曰经皮脊柱曰内镜曰治疗[中图分类号]R5[文献标识码]A[文章编号]1674-074圆渊圆园员9冤09渊a冤原园025-043例袁其中内固定1例遥术后采用椎管MRI检查评价患者的切除情况袁采用脊柱CT三维重建或脊柱x线检查评价脊EndoscopicTreatmentofLumbarSpinalCanalWANGSheng-li,ZHANGMei-ju,ZHANGQing-linDepartmentofOrthopaedics,WenshangCountyPeople'sHospital,Jining,ShandongProvince,272501China[Abstract]ObjectiveToinvestigatetheeffectofpercutaneousspinalendoscopicmicrosurgeryinthelumbarspinalcanal.MethodsTheclinicaldataof15patientswithlumbarspinalcanalocclusioninhospitalneurosurgeryfromJanuary2017toFebruary2019wereretrospectivelyanalyzed.Xiao'simprovedzoningstaging:6casesinstageI,5casesinstageII,3casescasesofinternalfixation;3casesofposteriormedianapproachforspineprocessandlaminectomy;3casesofanteriorcervi鄄instageIII,and1caseinstageIV.Surgicalprocedure:9casesofposteriormediansemi-laminarapproach,including2calapproach,includinginternalfixation1case.SpinalMRIwasusedtoevaluatetheresectionofthepatients.SpinalCTthree-dimensionalreconstructionorspinalx-rayexaminationwasusedtoevaluatethestabilityofthespine.TheFrankelgradingcriteriawereusedtoevaluatetherecoveryofspinalcordfunction.ResultsAll15patientsinthisgroupwereallre鄄movedinthenextstageofthemicroscope.Tumorproperties:14casesofschwannomasand1caseofganglioneuroma.Therewasnocerebrospinalfluidleakageandwoundinfectionafteroperation.PostoperativeFrankelgradingshowedthatthepa鄄tient'sspinalcordfunctionrecoveredfromgradeDin4casesandgradeEin11cases.Thepatientswerefollowedupfor1-24months,withanaverageof13months.Therewasnotumorrecurrenceandspinalinstability.ConclusionTheinternalandexternalcommunicationtumorsofthecervicalspineshouldbeselectedaccordingtotheappropriatesurgicalapproach.Microscopically,thetumorcanbecompletelycutinonestage.Ifnecessary,thecorrespondingvertebralreconstructionandspinalinternalfixationshouldbeperformedtomaintainthestabilityofthespine.[Keywords]Lumbarspinalcanal;Bonemassoccupying;Percutaneousspine;Endoscopy;Treatment椎管内外沟通性肿瘤常通过椎间孔沟通椎管内外袁呈野哑铃冶状结构袁以颈段为主袁神经鞘瘤多见袁约占椎管肿瘤的15豫耀38豫袁有35豫~50豫椎管内外沟通性肿[作者简介]王胜利渊1979-冤袁男袁山东济宁人袁本科袁主治医师袁研究方向院脊柱外科遥特殊性袁导致肿瘤一期全切困难度大袁以前学者进行椎合适的手术入路袁术中分块显微全切肿瘤袁并维持脊柱稳定性是该肿瘤手术的关键点遥该院神经外科自2017年1月要2019年2月共行颈段椎管内外沟通性肿瘤手术15例袁疗效满意袁现报道如下遥China&ForeignMedicalTreatment中外医疗管内外分期手术方式袁给患者造成很大的创伤[2]遥选择瘤可引起椎体及其附件骨质的破坏[1]遥因其生长方式的25
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