《颈椎管肿瘤Asazuma分型对手术入路选择的意义》.docVIP

颈椎管肿瘤Asazuma分型对手术入路选择的意义 作者：李忠海 作者单位：上海市长海医院骨科，上海 200433 【摘要】 目的 探讨颈椎管哑铃形神经鞘瘤的手术治疗方法及Asazuma分型在手术入路选择中的临床价值。方法 总结我院2004年2月至2007年3月收治的13 例颈椎管哑铃形肿瘤患者的临床表现、影像学特征、手术方式及手术前后患者脊髓神经功能改善情况，术前按照Asazuma分型进行评估，选择合适的手术入路，观察临床疗效，评估其临床应用价值。结果 13 例患者术前均经CT和MRI检查作出临床诊断，2 例Ⅰ型，1 例Ⅱa型，2 例Ⅲa型，2 例Ⅲb型，1 例Ⅴ型，1 例Ⅵ型采用后方入路，2 例Ⅱc型采用前方入路，2 例Ⅵ型采用前后联合入路。其中肿瘤完全切除11 例(84.6％)，大部切除2 例(15.4％)。3 例患者术中同时切除宿主神经根。10 例行内固定和植骨融合术。13 例随访3个月至3年，平均16个月。所有患者术后临床症状及神经功能均有明显恢复。结论 颈椎哑铃形椎管内肿瘤有较高的误诊、漏诊率，MRI检查对明确病变性质和位置有重要意义。Asazuma分型对颈椎管哑铃形神经鞘瘤的手术入路选择具有指导意义。 【关键词】 神经鞘瘤 颈椎 哑铃形 手术切除 The Asazuma Classification is a Perfect Assessment in Guiding Proper Surgical Approach to Cervical Dumbbell Tumors LI Zhonghai，ZHAO Jie，HOU Tiesheng，et al (Department of Orthopedics，Changhai Hospital in Shanghai，Shanghai 200433，China) Abstract：Objective To explore an optimal surgical management for cervical dumbbell tumors and to investigate the clinical value about the Asazuma classification in selecting the proper surgical approach to cervical dumbbell tumors.Methods Thirteen cases of cervical dumbbell tumors were retrospectely investigated from February 2004 to March 2007.All characteristies of those cases were recored and analyzed carefully，including the clinical manifestation，the image document，spinal cord or neural fuction and the surgical management.The surgical approach of these patients were selected by Asazuma classification.Thirteen patients of them were followed up，the clinical value about Asazuma classification was evaluated by observing the clinical effects.Results Thirteen patients were diagnosed by CT or/and MRI.Posterior approach was used in 9 patients(type Ⅰ2，type Ⅱa 1，type Ⅲa 2，type Ⅲb 2，type Ⅴ1，type Ⅵ 1)；anterior approach was used for all type Ⅱc tumors：a combined posterior and anterior approach was used for the remainder of type Ⅵ.Resection was subtotal in 2 patients(15.4％) and total in 11(84.6％).Three cases who underwent surgery for spinal schwannomas were removed together with functionally rele