摘要是原來發(fā)表時(shí)已經(jīng)翻譯好的!

1、摘要是原來發(fā)表時(shí)已經(jīng)翻譯好的！后路椎板切除、釘棒系統(tǒng)內(nèi)固定治療上頸椎椎管內(nèi)腫瘤Treatment of canal tumors of the upper cervical spine by posterior laminectomy and fixation screw rod system【摘要】目的探討后路椎板切除、釘棒系統(tǒng)內(nèi)固定及自體髂骨植骨融合術(shù)治療上頸椎椎管內(nèi)腫瘤的方法及療效。方法2003年1月至2008年6月，共收治上頸椎椎管內(nèi)腫瘤患者16例，男10例，女6例；年齡33-68歲，平均44.7歲。硬膜外腫瘤2例，硬脊膜下脊髓外腫瘤13例，髓內(nèi)腫瘤1例。腫瘤位于延髓-C1，3例，C1

2、,2 8例，C2水平2例，C1-3 2例，C2,3 l例；其中4例腫瘤位于頸髓腹側(cè)。15例患者行CT或MR檢查示腫瘤組織壓迫脊髓。Frankel分級：C級5例，D級10例，E級1例。采用后路椎板切除腫瘤，同時(shí)行釘棒系統(tǒng)內(nèi)固定及自體髂骨植骨融合術(shù)。結(jié)果所有患者術(shù)后均獲得隨訪，隨訪時(shí)間8個(gè)月，平均27.4個(gè)月。根據(jù)JOA 17分法評分，術(shù)前爭6-17分，平均88分；術(shù)后6個(gè)月14-17分，平均16分，平均改善率881。術(shù)后影像學(xué)檢查示植骨融合良好。Frankel分級：7例由術(shù)前的D級恢復(fù)至E級，5例由C級恢復(fù)至D級，3例D級及l(fā)例E級的患者術(shù)后未改變。結(jié)論后路椎板切除腫瘤、釘棒系統(tǒng)內(nèi)固定及植骨融合

3、治療上頸椎椎管內(nèi)腫瘤，可徹底切除腫瘤病灶，解除頸脊髓及神經(jīng)根壓迫，重建上頸椎的穩(wěn)定?！娟P(guān)鍵詞】頸椎；椎管；腫瘤；內(nèi)固定器【Abstract】Objective To investigate the methods and curative effects of posterior laminectomy and fixation screw rod system in treatment of canal tumors of the upper cervical spineMethods Between January 2003 and June 2008，16 patients(10 mal

4、es and 6 females，average age 44.7 years，range 33-68 years)with canal tumor of the upper cervical spine were treated，including epidural neoplasms in 2 cases,intradural extramedullary tumors in 13, and intramedullary tumor in l caseThe tumors were located between medulla oblongata and C1 in 3 cases，C1

5、,2 in 8，C2 in 2，Cl-3 in 2，C2,3 in l；4 cases were located at ventralis of cervical cordSpinal cord was pressed by tissue of tumor in Fifteen patients which were diagnosed by MRI and computerized tomographic(CT)scansAccording to the Frankel grading system，there Was C in 5 eases，D in 10 casesE in l cas

6、eThey were treated by posterior approach to remove of tumors after laminectomy，fixation with pedicle screw rod system and fusion with autogenous bone graftsResults The follow up was obtained for 6-58 months(mean 27.4 months)According to the JOA grading system，the preoperative average score was 8.8，1

7、6 at 6 months postoperatively, and the average improvement rate was 88.1According to the Frankel grading system，7 cases improved from D to E，5 from C to D，but none in 3 cases with Frankel D and l with EThe good fusion of bone graft Was found in iconography examinationConclusion The treatment by post

8、erior approach to remove of tumors after lamineetomy，and fixation with pedicle screw system and fuIsion with autogenous bone grafts，can relive compression of cervical cord，nerve root，remove of tumor lesion thoroughly，reconstruct stabilization of the upper cervical spine and improve life quality of p

9、atients【Key words】Cervical vertebrae；Spinal canal；Neoplasms；Internal fixators上頸椎椎管內(nèi)腫瘤一般指位于C1-3水平節(jié)段的腫瘤，可造成上頸髓及延髓受壓，引起呼吸循環(huán)障礙，導(dǎo)致高位截癱，甚至死亡。早期癥狀不明顯，常表現(xiàn)為單純枕頸部疼痛或不適、頭頸歪斜、頭頸部旋轉(zhuǎn)活動(dòng)受限，早期若無錐體束征等脊髓受壓的表現(xiàn)，無明顯的神經(jīng)定位體征，易誤診或漏診。目前，外科手術(shù)切除腫瘤病灶，解除對頸脊髓、神經(jīng)根、椎動(dòng)脈的壓迫，內(nèi)固定重建頸椎結(jié)構(gòu)的穩(wěn)定性，仍然是上頸椎腫瘤最有效、最主要的治療方法。A tumor located at C1-3 c

10、alled canal tumors of the upper cervical spine. It may compress the upper cervical cord or the medulla oblongata which can cause respiratory and circulatory disorder, high paraplegia and even death. The early symptoms were not manifest, often simple occipital and neck pain or discomfort, neck tilted

11、, neck rotate limited. There was no neurological sign without spinal cord compression symptoms such as pyramid sign and often misdiagnosis or missed diagnosis. At present, surgical resection of the tumor lesion to relieved the compression of spinal cord, nerve root and vertebral artery, fixation sta

12、bility of cervical structure, reconstruct stabilization of the cervical spine with fixation is still the most effective and most important therapy of canal tumors of the upper cervical spine.資料與方法Material and methods一、一般資料1. Physical data 2003年1月至2008年6月，采用頸椎后路經(jīng)椎板切除腫瘤、釘棒系統(tǒng)內(nèi)固定及髂骨植骨融合治療上頸椎椎管內(nèi)腫瘤患者16例，男

13、10例，女6例；年齡33-68歲，平均44.7歲(表1)。硬膜外腫瘤2例(均為神經(jīng)鞘瘤)，硬膜內(nèi)髓外腫瘤13例(神經(jīng)鞘瘤7例，脊膜瘤3例，脂肪瘤2例，神經(jīng)纖維瘤1例)，髓內(nèi)腫瘤1例(室管膜瘤)。腫瘤位于延髓C1 3例，C1，2 8例，C2水平2例，C1-3 2例，C2，3 l例；其中4例腫瘤位于頸髓腹側(cè)。Between January 2003 and June 2008，16 patients(10 males and 6 females，average age 44.7 years, range 33-68 years) with canal tumor of the upper cerv

14、ical spine were treated by posterior laminectomy, fixation screw rod system and graft with autogenous iliac crest (table 1), including epidural neoplasms in 2 cases (Schwannoma)，intradural extramedullary tumors in 13 cases(Schwannoma in 7 cases, meningioma in 3 cases; lipoma in 2 cases; neurofibroma

15、 in 1 case)and intramedullary tumor in l case(ependymoma)The tumors were located between medulla oblongata and C1 in 3 eases，C1-2 in 8，C2 in 2，Cl-3 in 2，C2-3 in l；4 cases were located at ventralis of cervical cordTable 1 16 patients generally data and resultsCaseAge(y)GenderEtipathologyTumor located

16、Following-up time(Mo)Frankel gradingJOA gradingimprovement ratePreo6 Mo postoPreo6 Mo posto146FSchwannomaC28DE81688.9239MSchwannomaC1,226DD81577.8368FSchwannomaC1-312DE717100.0446MSchwannomamedulla oblongata to C118CD71580.0533MSchwannomaC1,26DE1117100.0648FSchwannomaC1,258CD61581.8741MSchwannomaC1,

17、226DD141666.7834MSchwannomaC1,235CD61472.7936MSchwannomamedulla oblongata to C19DE1017100.01052FMeningiomaC1,218DE1017100.01147FMeningiomaC1,244DE917100.01244MMeningiomaC1,217DE917100.01337MLipomaC225EE1717-1449MLipomaC1-349CD61472.71540MNeurofibromaC2,321DD81688.91655MEpendymomamedulla oblongata to

18、 C127CD71681.8Average44.724.98.81688.1JOA Improvement rate (%) = ×100Case 13 was asymptomatic preoperative and postoperative and no evaluate the improvement rate.二、病程及臨床表現(xiàn)2. The history and clinical manifestation本組患者9例病程為10個(gè)月4年，7例為6一10個(gè)月。除l例患者因腫瘤較小而無神經(jīng)受損及脊髓壓迫癥狀外，余15例患者均表現(xiàn)為不同程度的頸部疼痛、頭部旋轉(zhuǎn)活動(dòng)受限、上肢酸

19、痛麻木，其中7例存在神經(jīng)根受壓癥狀，表現(xiàn)為一側(cè)上肢麻木、肩臂放射性疼痛、肌力45級，2例雙上肢肌力約3級，5例伴胸部束帶感及下肢酸痛麻木，有踩棉花感；1例伴雙下肢無力，行走困難。根據(jù)JOA 17分法評分1，術(shù)前6-17分，平均8.8分。按Frankel分級2：C級5例，D級10例，E級1例。肱二頭肌反射、肱三頭肌反射活躍6例，膝、跟腱反射活躍7例，髕、踝陣攣陽性7例，12例Hoffmann征陽性，Babinski征陽性。15例CT或MR檢查提示腫瘤組織壓迫脊髓。In the study, 9 cases of patients with course for 10 months to 4 ye

20、ars, 7 cases 6 to 10 months. In one case, the tumor was smaller and without Symptoms of nerve injury and spinal cord compression. The other 15 patients had various degrees of neck pain, neck rotate limited, upper extremities aching pain and anaesthesia, and 7 of them had nerve root compression sympt

21、oms such as one side of upper extremity anaesthesia, shoulder and arm radiated pain, muscle strength 4-5/5; 2 cases muscle strength was 3/5; 5 cases together with chest band lower extremities aching pain and anaesthesia and has a sense of Step on Cotton; 1 case together with both lower extremities a

22、dynamia and dys-walks. According to the JOA grading system1, the preoperative average score was 8.8(range from 6 to 17). According to the Frankel grading system2，there was 5 cases with Frankel C, l0 with D and 1 with E6 cases biceps jerk and triceps reflex activity, 7 cases quadriceps reflex and ach

23、illes jerk activity, 7 cases trepidation sign and ankle-clonus positive, 12 cases Hoffmann sign and Babinski sign positive. Spinal cord was pressed by tissue of tumor in Fifteen patients which were diagnosed by MRI and computerized tomographic(CT)scans三、輔助檢查3. The auxiliary examination (一)X線及CT掃描：16

24、例均行頸椎正、側(cè)位X線檢查及CT掃描，6例表現(xiàn)為椎弓根變形，椎弓根間距增寬，3例見椎間孔擴(kuò)大，2例椎體后部有弧形壓跡改變，椎體骨質(zhì)吸收(圖1)。a. X-rays and CT scans. 16 cases were performed cervical anteroposterior, lateral x-rays and CT scans. 6 of them with pediculus arcus vertebrae deformation, interpedicular distance widen; 3 cases intervertebral foramina dilatati

25、on, posterior centrum comma impression and vertebral bone absorption could found in 2 cases.Figure 1 Female, 68 years. CT scans showed the left margin of C2 vertebral has tumor notch, sclerotin oppressed and absorbed, osseous canal broaden.(二)MR檢查：16例均行MR檢查，3例表現(xiàn)為啞鈴形腫塊，在T1WI呈等信號(hào)，在T2WI呈高信號(hào)，伴一側(cè)椎間孔擴(kuò)大。9例

26、神經(jīng)鞘瘤、3例脊膜瘤及2例脂肪瘤示椎管硬膜內(nèi)及脊髓外圓形或橢圓形占位，邊界清晰，T1WI呈等信號(hào)，T2WI呈高信號(hào)，部分病灶T2WI呈低信號(hào)(病灶出血)，信號(hào)均勻或不均勻改變，上頸髓受壓移位，3例延髓C1水平患者均無延髓受壓。1例(例16)室管膜瘤增強(qiáng)MRI顯示信號(hào)增強(qiáng)，輪廓尚清晰。1例(例15)神經(jīng)纖維瘤T1WI呈等信號(hào)，T2WI呈不均勻高信號(hào)，邊界稍模糊。b. MR examination. All 16 cases performed MR examination, 3 cases with dumbbell shaped mass, isointensity in T1WI signa

27、l, high-intensity in T2WI and one side of intervertebral foramina dilatation. 14 cases(Schwannoma in 9 cases, meningioma in 3 cases; lipoma in 2 cases) showed intradural extramedullary has round or oval occupied and bouncary were clear, isointensity in T1WI signal, high-intensity in T2WI, some of th

28、e lesions which with bleeding had uniformity or uneven low-intensity in T2WI, the upper cervical spine compressed and displaced. 3 cases whos tumors were located between medulla oblongata and C1 without medulla compression. Enhanced MRI showed signal enhancement and circumsciption clear in 1 case (c

29、ase 16) which with ependymoma. 1 case (case 15) with neurofibromatosis had isointensity in T1WI signal, uneven high-intensity in T2WI and bouncary was obfuscation.四、手術(shù)方法4. Surgical(一)術(shù)前準(zhǔn)備A Preoperative preparation1手術(shù)前的影像學(xué)檢查，特別是MR檢查對于確定腫瘤組織的范圍、椎動(dòng)脈的走行、椎動(dòng)脈是否迂曲受壓、腫瘤組織與脊髓神經(jīng)的關(guān)系等非常重要。a. Preoperative imagin

30、g examination especially MR imaging examination is very important to determine the circumsciption of tumors, the tendency of vertebral artery, whether the vertebral artery circuitous and compression or not and the relationship of the tumor and spinal nerves.2術(shù)前準(zhǔn)備大劑量的甲基潑尼松龍，待術(shù)中切除腫瘤時(shí)，應(yīng)用沖擊療法，以保護(hù)脊髓，減少炎癥

31、反應(yīng)3，同時(shí)靜滴抑制胃酸藥物，以防應(yīng)激性潰瘍。b. Preparation high-dose methyllprednisolone preoperative and stosstherapy when resection the tumor to protect the spinal cord and reduce inflammation 3, and intravenous drip infusion acid-inhibitory drugs to avoid stress ulcer at the same time.3術(shù)前右側(cè)股靜脈穿刺，在透視引導(dǎo)下將心臟臨時(shí)起搏器導(dǎo)線置入右心室

32、，接心臟起搏器，預(yù)防術(shù)中及術(shù)后的心臟驟停。c. Right femoral venous puncture preoperative and isertion temporary cardiac pacemakers guideline into right ventricular with fluoroscopy guided to prevent cardiac arrest intraoperative and postoperative.(二)手術(shù)過程B. Operations全麻氣管內(nèi)插管，俯臥位，“U”形枕墊起胸腹部，頭部置于頭架上。經(jīng)后正中入路切開皮膚及皮下組織，充分顯露枕骨后側(cè)

33、及寰樞椎棘突、椎板和小關(guān)節(jié)突。因腫瘤切除后，寰樞椎后方結(jié)構(gòu)缺如，故先置入椎弓根螺釘，并于遠(yuǎn)離腫瘤一側(cè)置人棒并旋緊，維持上頸椎穩(wěn)定。切除椎板顯露腫瘤，切除的椎板以能顯露腫瘤上下極為界，盡量行假膜外切除腫瘤；除2例硬膜外腫瘤無須切開硬膜外，14例硬膜內(nèi)腫瘤均切開硬脊膜，切開硬脊膜，以細(xì)絲線將硬脊膜懸吊于四周，沿脊髓外側(cè)并分離蛛網(wǎng)膜顯露脊髓和神經(jīng)根。充分暴露腫瘤，一手用神經(jīng)剝離子輕輕抵住腫瘤，另一手用另一神經(jīng)剝離子分離脊髓與腫瘤的界面，沿腫瘤的上下極分離切除腫瘤。位于腹側(cè)的腫瘤，可用絲線先將腫瘤固定，然后小心剝離，盡量向腫瘤一側(cè)輕輕提起，分離時(shí)盡量將神經(jīng)剝離子穩(wěn)定脊髓側(cè)，避免過度牽拉脊髓，另一側(cè)置入

34、棒并旋緊螺釘。最后取大塊髂骨植骨。General anaesthesia by intratracheal insufflation, prone posture, and “U" shaped pillow underlay the chest and abdomen and the head keep in spindle stock. Incise skin and hypodermis by posteromedian approach, revealed the posterior aspect of the occipital, acanthi of the atlant

35、oaxial, vertabral lamina and facets. Because rear structure of atlantoaxial vertebral absence after tumor resection, so we inserted the pedicle screws and the bar away from the tumor and tighten the bar first to maintain the upper cervical stability. Laminectomy to reveal the upper pole and perineum

36、 of the tumor and removed the tumor within false memebrane as possible as we can. Except two cases who suffered by epidural neoplasms without incise the meninx fibrosa. 14 cases who suffered by intradural neoplasms incise the meninx fibrosa. Hang on the meninx fibrasa with silk after incise it. Disa

37、ssociate arachnoid outsid spinal cord to expose spinal cord and nerve root. A nerve dissector resists the tumor; the other one disassociates tumor and spinal cord and resects the tumor. If the tumor located at ventralis of cervical cord, fix the tumor by silk first and then disassociate the tumor. S

38、table the spinal cord as far as possible when disassociate and avoid over-stretching the spinal cord. Insert the other bar and tight the screw. Finally, autogeneous iliac bone grafting.五、術(shù)后處理5. Postoperative treatment術(shù)后床邊常規(guī)準(zhǔn)備氣管切開包及呼吸機(jī)。復(fù)查血?dú)夥治?、血常?guī)、電解質(zhì)，以防內(nèi)環(huán)境紊亂。術(shù)后常規(guī)激素治療：術(shù)后第1天給予靜脈滴注地塞米松10mg，2次；第2天5 mg，2次

39、；第3天5 mg，1次；第4天停藥4。同時(shí)應(yīng)用抗生素、神經(jīng)營養(yǎng)劑、脫水劑。術(shù)后9-12 d，可在頸圍保護(hù)下下床活動(dòng)。臥床3周，頸托保護(hù)36個(gè)月。常規(guī)行放射學(xué)檢查明確內(nèi)固定位置及植骨融合情況。根據(jù)患者的腫瘤病理類型選擇化療或放療。Postoperative, prepared tracheotomy instruments set and breathing machine routinely. Reexamined blood gas analysis, routine blood test and electrolysis to prevent internal environment di

40、sorder. Therapy with hormone regularly: intravenous drip dexamethasone 10mg twice in the first day after surgery, 5mg twice in the second day, 5mg once in the third day, stop in the forth day4. Intravenous drip antibiotics, nerve nutritional agent and dehydrater at the same time. 9-12 days after sur

41、gery, the patient cans out-of-bed activity with neck collar. Bed ridden 3 weeks and protect by neck collar 3- 6 months. Radiological examination to identify fixation position and bone fusion status. Choose chemotherapy or radiotherapy according to the pathological of tumor.結(jié)果Results本組16例患者，除l例(例14)腫

42、瘤較大位于頸髓腹側(cè)和椎間孔行次全切除外，其余腫瘤均全部切除。手術(shù)時(shí)間165280 min，平均218.7 min。術(shù)中出血8002300 ml，平均1324.4 ml。15 patients tumor performed total excision, 1 case (case 14) which tumor was located at ventralis of cervical cord and intervertebral foramina performed subtotal ectomy. Average operative time was 218.7min (range fro

43、m 165 to 280min). Average intraoperative hemorrhage was 1324.4ml (range from 800 to 2300ml). 術(shù)后所有病例均未出現(xiàn)與內(nèi)固定有關(guān)的神經(jīng)脊髓損傷和腦脊液漏等并發(fā)癥。無一例發(fā)生切口感染及出現(xiàn)眩暈、頸痛、頭痛等頸椎不穩(wěn)的表現(xiàn)。術(shù)后3周左右脊髓功能恢復(fù)至最終水平，枕頸部疼痛或眩暈較術(shù)前減輕，甚至恢復(fù)正常，四肢麻木感一般較術(shù)前好轉(zhuǎn)，但持續(xù)時(shí)間較長。Postoperative all cases had not complications which related with internal fixation su

44、ch as spinal cord injury and leakage of cerebrospinal fluid. No wound infection and cervical instability symptoms such as giddiness, neck pain and headache. About 3 weeks after surgery, the spinal functional recoveries come to the final level. Compare with the preoperative, neck pain or giddiness le

45、ssen even became normal, limbs anesthesia reduced generality but last a longer time.全部患者均獲得隨訪，隨訪時(shí)間6-58個(gè)月，平均24.9個(gè)月。術(shù)后X線片和CT掃描顯示植骨融合良好，頸脊髓、神經(jīng)根壓迫均解除。骨性融合時(shí)間35個(gè)月，平均36個(gè)月；無一例發(fā)生內(nèi)固定松動(dòng)、移位和斷裂(圖2)。脊髓神經(jīng)功能均有不同程度恢復(fù)，術(shù)后6個(gè)月JOA評分14-17分，平均16分，平均改善率881。根據(jù)Frankel分級，7例由術(shù)前的D級恢復(fù)至E級，5例由術(shù)前的C級恢復(fù)至D級，3例術(shù)前D級及l(fā)例術(shù)前E級的患者術(shù)后未改變(表1)。l例

46、(例3)硬膜外腫瘤累及C2椎體左后方，因腫瘤與C2神經(jīng)根粘連，將C2神經(jīng)根一側(cè)切斷后摘除腫瘤，術(shù)后患者未出現(xiàn)任何明顯不適。本組5例患者至末次隨訪時(shí)軀干或四肢仍存在麻木感。1例(例7)神經(jīng)鞘瘤患者于術(shù)后24個(gè)月復(fù)發(fā)，再次行手術(shù)切除。本組無一例死亡病例。All patients follow-up 6-58 months(mean 27.9 months)Postoperative X-ray and CT scan showed bone grafts were good fusion; cervical spinal cord and nerve root compression were r

47、elieved. The solid fusion time was about 3-5 months (mean 3.6months). There were no fixation loosening, displace and disrupt (figure 2). Spinal nerves function recovered in various degrees. According to the JOA grading system，at 6 months postoperatively, the average score was 16(range from 14 to 17)

48、 and the average improvement rate was 88.1According to the Frankel grading system，7 cases improved from D to E，5 from C to D，but none in 3 cases with Frankel D and l with E(table 1)1 epidural neoplasm (case 13) involved left-back part of the C2 centrum and the tumor was adhering to the C2 nerve root

49、. The nerve root has been cut off when removed the tumor and patient didnt suffer any discomfortable postoperative. 5 cases has trunk and limbs anesthesia at last follow-up.1 patient (case 7) who suffer from schwannoma recurrent in 24 months after resection and exairesis one more time. No deaths in

50、our study. Figure 2, female, 52 years, a,b Preoperative sagittal and coronal MRI showing the tumor is located in front of the spinal cord; deflected to the left, spinal cord compressed and displaced to the right side. c Postoperative MRI showed it decompressed to the C3 vertebral level, spinal cord

51、compression has been completely lifted. d 18 months postoperative, cervical spine radiogram showed implanted bone fusion and internal fixation no loosening, displacement and disruption. e,f 18 months postoperative the patient can fasten button and use chopsticks.討論Discussion上頸椎椎管內(nèi)腫瘤好發(fā)于為青壯年，腫瘤一般巨大。本組

52、患者平均年齡為44.7歲，16例患者中12例腫瘤至少跨過兩個(gè)節(jié)段。大多數(shù)患者病程較長，本組l例(例14)病程長達(dá)4年。Chevrot等5認(rèn)為，局部腫瘤是頸部疼痛的可能原因之一，應(yīng)對此類患者行影像學(xué)檢查，CT及MRI能提供更多的信息。我們認(rèn)為，對懷疑上頸椎椎管內(nèi)腫瘤的患者，應(yīng)及早進(jìn)行相應(yīng)檢查。上頸椎椎管內(nèi)腫瘤的典型X線表現(xiàn)為椎間孔擴(kuò)大，椎弓間距增寬等，但這些特征出現(xiàn)的比例不高6。CT、MR檢查能清晰顯示腫瘤侵犯的部位、范圍及椎管的完整性、與脊髓的關(guān)系、脊髓的受壓程度及椎旁軟組織的侵及范圍，診斷正確率較高7；特別是MR檢查，可清晰顯示腫瘤與周圍結(jié)構(gòu)尤其是椎動(dòng)脈被壓迫、移位等情況8。Canal tu

53、mors of the upper cervical spine often occur in teenager and the tumor size is huge. In our study, the average age was 44.7 years, and the tumor across two section at least in 12/16 cases. Most of the patients had a long history, 1 case (case 14) in our study was 4 years. Chevrot etc. 5 consider tha

54、t local tumor is one of the possible reasons of neck pain, so the patients who have neck pain should perform imaging examination, CT and MRI imaging can provide more information. In our opinion, the patients who suspect suffer from canal tumors of the upper cervical spine should perform correspondin

55、g check early. The typical characters of the canal tumors of the upper cervical spine in X-rays were intervertebral foramina dilatation, the distance of vertebral arch broaden and so on, but the frequency of those characters occurrences was low6. CT and MRI scan can display the location and extent o

56、f the tumor, completeness of the canal, the relationship of the tumor and spinal cord, the degree of compressed spinal cord and the extent encroach on paravertebral soft tissue, and the diagnostic accuracy is higher 7. Particularly, MR examination can show the relationship between the tumor and surr

57、ounding structure, especially the vertebral artery oppressed, displacement 8.一、手術(shù)入路的選擇1. Operation approach治療位于脊髓腹側(cè)的上頸椎椎管內(nèi)腫瘤的手術(shù)入路存在爭議。由于腫瘤位于上頸椎脊髓腹側(cè)，所以術(shù)中可能影響呼吸和心跳的機(jī)能，甚至危及生命。有學(xué)者采用前方入路，行前方椎體次全切進(jìn)入椎管后再行腫瘤切除。肖建如等6認(rèn)為，切除位于上頸椎腹側(cè)的腫瘤時(shí)，可選擇后側(cè)人路；切斷偏腫瘤一側(cè)的脊神經(jīng)后根9，在背外側(cè)分離瘤體，掛線牽引方法將腫瘤切除。Acosta等10采用后側(cè)旁正中經(jīng)椎弓根入路，游離椎動(dòng)脈及神經(jīng)根

58、，亦可安全切除位于脊髓腹側(cè)的腫瘤。我們認(rèn)為，只要掌握頸椎解剖特點(diǎn)、術(shù)前明確腫瘤大小以及腫瘤與脊髓關(guān)系、術(shù)中仔細(xì)操作，后方入路行上頸椎椎管內(nèi)腫瘤切除一般不會(huì)發(fā)生嚴(yán)重脊髓干擾，可完全切除大多數(shù)腫瘤。Operative approach of canal tumors of the upper cervical spine which located at ventralis of cervical cord is controversial. Because the tumors located at ventralis of cervical cord, so the breathing and heartbeat function may be affec