一期后路手术切除Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤的可行性与疗效

Efficacy and feasibility of one-stage posterior approach for Toyama Ⅲb and Ⅵ inner and outer dumbbell tumors in upper cervical spinal canal

中文关键词:  上颈椎  哑铃状肿瘤  Toyama分型  手术治疗

英文关键词:Upper cervical spine  Dumbbell tumor  Toyama classification  Surgical treatment

中文摘要:

  【摘要】 目的：探讨一期后路手术切除Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤的可行性及短期临床疗效。方法：回顾性分析2006年1月~2016年1月收治的10例Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤患者，其中男8例，女2例，年龄40~65岁，平均56.2±7.8岁。神经鞘瘤8例，神经纤维瘤2例。肿瘤位于C1/2 5例，C2/3 3例，C3/4 2例。Toyama Ⅲb型7例，Ⅵ型3例。术前行MRI测量椎管外肿瘤距离硬膜囊边缘的最大径为4.0~6.5cm，平均4.8±0.7cm；JOA评分平均为9.5±3.5分；ASIA分级，B级1例，C级1例，D级2例，E级6例。均采用一期后路手术切除肿瘤及单侧内固定重建颈椎的稳定性，术后行JOA评分及ASIA残损分级评价神经功能改善情况，复查X线评估颈椎的稳定性。结果：所有的肿瘤均一期后路完全切除，其中椎管外瘤体均是完整的整块切除，无椎动脉损伤、神经功能障碍加重。手术时间为210~270min（231.0±18.5min），术中出血量为400~700ml（550.0±87.9ml），住院时间为6～8d（7.2±0.8d）。随访6~15个月，平均12.0±3.0个月，随访期间未见肿瘤复发者，患者的神经症状及阳性体征较术前明显改善。术后半年的平均JOA评分为15.4±1.4分，与术前比较差异有统计学意义（P＜0.05）；ASIA分级D级1例，E级9例，末次随访时D级1例也恢复到E级，末次随访与术前ASIA分级比较差异具有统计学意义（P＜0.05）。10例患者随访期间无内固定松动和后凸畸形的发生。结论：Toyama Ⅲb和Ⅵ型上颈椎椎管内外哑铃形肿瘤可经一期后路手术切除并恢复颈椎的稳定性，短期的临床疗效较满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the feasibility and short-term clinical efficacy of one-stage posterior surgical resection for Toyama Ⅲb and Ⅵ upper cervical spinal canal inner and outer dumbbell tumors. Methods: From January 2006 to January 2016, 10 cases with Toyama Ⅲb and Ⅵ inner and outer upper cervical spinal canal dumbbell tumors undergoing resection of tumors and reconstruction of spinal stability by one-stage posterior approach were reviewed retrospectively. There were 8 males and 2 females, with a mean age of 56.2±7.8 years(range, 40-65 years). There were 8 with neurinoma and 2 with neurofibroma. Based on the tumor site, there were 5 cases in C1/2, 3 in C2/3, and 2 in C3/4. According to Toyama classification, there were 7 cases of Ⅲb and 3 cases of Ⅵ. Before operation, the maximum diameter from the tumor outside of spinal canal to dural margin measured in preoperative MRI image was 4.0-6.5cm(mean 4.8±0.7cm); the average JOA score was 9.5±3.5. Based on the ASIA classification, 1 case was in grade B, 1 in grade C, 2 in grade D and 6 in grade E. After operation, neurological function was evaluated by JOA score and ASIA grade. Besides, X-ray was reviewed to assess the stability of cervical spine. Results: All tumors were resected successfully by one-stage posterior approach, and the tumor outside of spinal canal was en bloc excision, without vertebral artery injury and deteriorative neurological function. The average operation time was 231.0±18.5min(range, 210-270min), the average intraoperative blood loss was 550.0±87.9ml(range, 400-700ml), and the average discharge time was 7.2±0.8 days(range, 6-8 days). All patients had a follow-up of 6-15 months(mean, 12.0±3.0 months), no tumor recurrence was noted, the neurological symptoms and positive signs of patients were significantly relieved after operation. At 6 months after operation, the mean JOA score of postoperation was 15.4±1.4, which showed statistically significant difference compared with that of preoperation(P<0.05). There were 1 case in grade D and 9 cases in grade E based on ASIA classification, the only one case in grade D also recovered to grade E at final follow-up, and there were significant differences between preoperation and final follow-up(P<0.05). Instrument failure or kyphosis was not detected in 10 patients. Conclusions: The Toyama Ⅲb and Ⅵ inner and outer upper cervical spinal canal dumbbell tumors can be surgically removed and the stability of cervical spine can be reconstructed by one-stage posterior approach, the short-term clinical efficacy is satisfactory.