目的研究半椎板切除、全椎板切除及椎板回植成形对颈椎稳定性的影响。方法将14例新鲜成年绵羊颈椎标本(C2~7)分为两组,每组7例。每例标本均被施加前屈后伸、左右侧弯和左右轴向旋转6个方向3.0 N·m载荷,测量C3~6运动节段在不同载荷下的运动范围(range of motion,ROM)及中性区(neutral zone,NZ)。对第1组进行完整状态、C5半椎板切除和C4~6半椎板切除3种状态下标本ROM和NZ的测量。对第2组进行完整状态、C4~6全椎板切除和C4~6椎板回植成形3种状态下标本ROM和NZ的测量。结果与完整状态比较,C5半椎板切除和C4~6半椎板切除状态下标本ROM和NZ没有明显差异,且C5半椎板切除和C4~6半椎板切除两种状态之间标本ROM和NZ也没有显著性差异。与完整状态比较,C4~6全椎板切除与C4~6椎板回植成形状态下在前屈后伸载荷下ROM有显著增大(P<0.05)。C4~6椎板回植成形与C4~6全椎板切除状态比较,标本在后伸载荷下ROM明显减小(P<0.05);而其余载荷下,椎板回植成形和全椎板切除ROM之间没有显著性差异。结论半椎板切除后,颈椎标本ROM和NZ无明显增加,并不影响颈椎的稳定性。全椎板切除后,颈椎标本在前屈后伸载荷下的ROM和NZ明显增加,颈椎稳定性受影响。椎板回植成形术并没有明显改善椎板切除术后颈椎的稳定性。
Background;Ganglioneuroma is a rare benign tumor,which is usually located in the posterior mediastinum and retroperitoneum.Occasionally,it involves the paraspinal region with intraspinal extension and becomes dumbbell shaped.Dumbbell ganglioneuromas rarely affect the lumbar spine,and only nine cases of dumbbell lumbar ganglioneuromas have been reported previously.Case presentation;We are reporting an extremely rare case of a giant dumbbell tumor in the lumbar spine.We performed a one stage total resection of the tumor with posterior approach and long-segment fixation and fusion.This approach is different from previous methods.Histopathological examination of the surgical specimen confirmed the diagnosis of ganglioneuroma.Thirty months follow up showed a satisfactory outcome.Conclusions:Single-stage posterior tumor resection with fixation and fusion is effective and an appropriate choice for the treatments of lumbar dumbbell ganglioneuromas.
