Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
J Clin Neurosci. 2011 Sep;18(9):1168-73. doi: 10.1016/j.jocn.2010.12.043. Epub 2011 Jul 16.
Removal of intraspinal tumors by the classic posterior midline approach with laminectomy may cause damage to and instability of cervical segments. We investigated whether the less invasive hemilaminectomy or hemi-semi-laminectomy can achieve satisfactory clinical outcomes in 39 patients with intraspinal extramedullary tumors of the cervical spine. Twenty-seven patients were treated with conventional microsurgery using a posterior midline approach; and were compared to 12 patients treated with hemilaminectomy or hemi-semi-laminectomy using a posterior midline approach. Patients were retrospectively reviewed and their preoperative and postoperative clinical status was measured using the Frankel Grade. The surgical time for the 27 patients who underwent a classical laminectomy was 3±0.39 hours and blood loss was 123±34 mL. Twenty-five patients had their tumors removed entirely, and two patients had partial removal. Twenty-six patients were followed-up for between 38 months and 7 years (mean=5 years), of whom 23 improved and three remained in a stable condition. One patient with a meningioma had a tumor recurrence 3 years post-operatively and underwent further surgery. The surgical time for the hemilaminectomy or hemi-semi-laminectomy group was 2.5±0.3 hours and blood loss was 88±18 mL. All patients were followed-up for between 26 and 42 months (mean=31 months) and 11 recovered to an improved grade while one remained in a stable condition. No patient had a tumor recurrence. The hemilaminectomy or hemi-semi-laminectomy approach achieved similar clinical outcomes to the conventional posterior midline laminectomy approach and was also associated with a shorter operative time, decreased intraoperative blood loss, greater preserved ligament and bone structure and a reduced deformity rate.
通过经典的后路正中切开椎板切除术切除椎管内肿瘤可能会导致颈椎节段的损伤和不稳定。我们研究了经后路半椎板切除术或半-半椎板切除术是否可以为 39 例颈椎椎管内髓外肿瘤患者获得满意的临床效果。27 例患者采用传统的后路正中切开显微镜下手术治疗；并与 12 例采用后路正中切开半椎板切除术或半-半椎板切除术的患者进行比较。回顾性分析患者的术前和术后临床状况，并采用 Frankel 分级进行测量。27 例行经典椎板切除术的患者的手术时间为 3±0.39 小时，失血量为 123±34ml。25 例患者肿瘤完全切除，2 例患者部分切除。26 例患者随访 38 个月至 7 年（平均 5 年），其中 23 例患者改善，3 例患者病情稳定。1 例脑膜瘤患者术后 3 年肿瘤复发，再次手术。半椎板切除术或半-半椎板切除术组的手术时间为 2.5±0.3 小时，失血量为 88±18ml。所有患者随访 26 至 42 个月（平均 31 个月），11 例患者恢复至改善分级，1 例患者病情稳定。无患者肿瘤复发。半椎板切除术或半-半椎板切除术与传统后路正中切开椎板切除术具有相似的临床效果，且手术时间更短，术中失血量更少，韧带和骨结构保留更好，畸形发生率更低。
