摘要： 目的 分析椎管内外沟通性“哑铃”形肿瘤的临床特点和显微手术治疗策略。方法 共39 例患者，分别采取单纯后正中入路手术（33 例）和前后路联合入路手术（6 例），其中30 例于肿瘤切除同期行脊柱内固定术（C_{3 ~ 7} 侧块螺钉植入、其余椎体节段行椎弓根螺钉植入）。结果 所有患者均达肿瘤全切除，术后随访6 个月至5 年，平均18.67 个月。术后疼痛明显改善29 例，平均视觉模拟评分由术前的7.51 ± 1.05 降至术后24 h 的3.17 ± 1.17（P < 0.05）；术后新发或感觉障碍区域扩大者12 例、无明显变化者3 例，美国脊髓损伤协会感觉评分由术前的218.67 ± 2.80 降至术后24 h 的213.33 ± 2.16（P < 0.05），术后6 个月时改善至216.78 ± 1.47（P < 0.05）；肢体运动功能改善18 例，美国脊髓损伤协会运动评分由术前的92.33 ± 1.63 提高至术后6 个月的95.05 ± 1.41（P < 0.05）。术后无一例肿瘤复发或继发脊柱畸形。结论 大多数椎管内外沟通性“哑铃”形肿瘤均可通过显微手术Ⅰ期完全切除。术前因骨质破坏或术中充分显露肿瘤而行椎间孔切开者，需于术中同时行植骨融合内固定以维持脊柱稳定性。手术相关视频链接：http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n12a3

关键词: 脊髓肿瘤, 椎管, 内固定术（非MeSH 词）, 显微外科手术

Abstract: Objective  To investigate the clinical features and surgical strategy of intra- and extra-vertebral dumbbell-shaped tumors.  Methods  Clinical data of 39 patients with intra- and extra-vertebral tumor were retrospectively studied. The tumors were removed via posterior midline approach in 33 patients, and via posterior combined with anterior approach in 6 patients. Thirty patients underwent tumor resection and internal fixation. Lateral mass screw fixation was performed in the level of C_3-7, while the pedicular screw fixation was performed in the level of C₂ and thoracic and lumbar segment.  Results  Tumors were totally excised in all the cases. The patients were followed-up for 6 months to 5 years with an average of 18.67 months. Pain relief occured in 29 cases, of whom the average Visual Analogue Scale (VAS) score decreased from (7.51 ± 1.05) before surgery to (3.17 ± 1.17) 24 h after surgery (P < 0.05). The numbness area emerged or enlarged in 12 cases and was unchanged in 3 cases. The average American Spinal Injury Association (ASIA) sensation score decreased from (218.67 ± 2.80) before surgery to (213.33 ± 2.16) 24 h after surgery (P < 0.05), but it increased to (216.78 ± 1.47) 6 months after operation (P < 0.05). The motor function improved in 18 cases, and ASIA motor function score improved from (92.33 ± 1.63) before surgery to (95.05 ± 1.41) 6 months after operation (P < 0.05). No tumor recurrence and secondary spinal deformity were found.  Conclusion  Most cases of dumbbell-shaped intra- and extra-vertebral tumor can be totally removed with one-session microsurgery. In the cases with bony erosion caused by tumor and facetectomy, concurrent internal fixation and fusion were recommended in order to maintain spinal stability.

Key words: Spinal cord neoplasms, Spinal canal, Internal fixation (not in MeSH), Microsurgery