摘要： 目的 探讨颈椎椎管“哑铃”形肿瘤之临床特点、分型及手术疗效。方法 回顾分析26 例颈椎椎管“哑铃”形肿瘤患者临床资料。根据影像学表现分为3 型，Ⅰ型以椎管内为主型（17 例），采用经后路入路手术，8 例辅助内固定术；Ⅱ型以椎管外为主型（4 例），采用经前外侧入路手术，均未行内固定术；Ⅲ型为椎管内外均衡型（5 例），采用前后路联合入路手术，均辅助内固定术。术中发现单侧关节突关节破坏者行颈椎稳定性重建，经后路行侧块或椎弓根螺钉内固定术，取自体髂骨行植骨融合术。结果 26 例中神经鞘膜瘤19 例、神经纤维瘤4 例、神经节细胞瘤2 例、脊膜瘤1 例。肿瘤全切除23 例、次全切除3 例，50%（13/26）患者肿瘤切除同期行内固定术，Ⅰ型8 例、Ⅲ 型5 例。平均随访30 个月，4 例（15.38%）复发，术后2 例发生切口感染及脑脊液漏，无一例发生脊髓损伤和脊柱后凸畸形。结论 根据影像学表现进行肿瘤分型并选择手术方式，有利于提高颈椎“哑铃”形肿瘤全切除率、降低复发率。脊柱稳定性被破坏者需同时行内固定以重建其稳定性。

关键词: 脊髓肿瘤, 椎管, 颈椎, 内固定术（非MeSH 词）, 骨移植, 髂骨, 外科手术, 磁共振成像

Abstract: Objective  To investigate the clinical characteristics, classification, surgical approach, complication and prognosis of cervical dumbbell-shaped tumors. Methods  Twenty-six consecutive cases with cervical dumbbell-shaped tumors were retrospectively studied. According to tumor location by imaging examination, all tumors were divided into 3 types. Type Ⅰ (17 cases) was mostly intravertebral and foraminal. Surgery through posterior approach was performed and internal fixation was operated in 8 cases. Type Ⅱ (4 cases) was mostly paravertebral and foraminal. Surgery through the anterolateral approach was performed without internal fixation. Type Ⅲ (5 cases) was equalization of intravertebral and paravertebral, and underwent surgery through combined posterior-anterolateral approach and internal fixation was performed in all of those cases. If the unilateral facet joint was destroyed, internal fixation was necessary. Lateral mass screw internal fixation and transpedicular screw fixation supplemented by fusion with autologous iliac bone graft were used to maintain cervical spinal stability.  Results  Among 26 patients there were 19 schwannomas, 4 neurofibromas, 2 gangliocytoma and 1 spinal meningioma. Total and subtotal tumor resection was achieved in 23 and 3 patients respectively. Among them 50% (13/26) of the cases were used internal fixation including 8 TypeⅠand 5 Type Ⅲ patients. The follow-up period was from 7 to 62 months, and mean time was 30 months. Four cases (15.38%) were found local tumor recurrence. Two cases suffered with surgical infection and cerebrospinal fluid leakage. There was no spinal cord injury and spinal deformity. Conclusion  In order to increase the total resection rate and decrease recurrence rate, surgical approach should be selected according to the imaging classification of tumors. Stability reconstruction is absolutely necessary for the patients with facet joint destroyed.

Key words: Spinal cord neoplasms, Spinal canal, Cervical vertebrae, Internal fixation (not in MeSH), Bone transplantation, Ilium, Surgical procedures, operative, Magnetic resonance imaging