颈椎椎板切除术后稳定性研究  

Spinal stability postlaminectomy in patients with cervical spinal cord tumor

作　　者：林国中[1] 王振宇[1] 谢京城[1] 李振东[1] 马长城[1] 刘彬[1] 陈晓东[1] 

机构地区：[1]北京大学第三医院神经外科,100191

出　　处：《北京医学》2010年第5期336-340,共5页Beijing Medical Journal

摘　　要：目的探讨颈椎椎板切除术对颈椎稳定性的影响及相关因素。方法回顾性分析1997年5月至2009年9月收治的62例颈椎椎管内肿瘤患者的资料。对手术前后的临床及医学影像进行复习,通过手术后随访评价患者脊柱生物力学的变化。结果62例按椎板切除数分为:A组(<3个)及B组(≥3个);按病变部位分为:C组(髓内)及D组(髓外)。患者近期及远期临床效果均满意。随访3个月至12年,颈椎不稳定发生率A组3.1%,B组16.7%,B组高于A组(P<0.05);C组36.4%,D组4.3%,C组高于D组(P<0.05)。颈椎曲度恶化发生率A组为3.1%,B组为23.3%,B组高于A组(P<0.05);C组45.5%,D组6.4%,C组高于D组(P<0.05)。结论椎板切除术式可导致颈椎生物力学的变化。椎板切除数≥3个,髓内占位或同时累及颈2及颈7时应注意术后不稳定或畸形的发生。Objective To investigate the postoperative changes of spinal stability and relevant factors followed laminectomy of removal of cervical spinal cord tumor.Methods The authors retrospectively analyzed a series of 62 patients with intra-spinal tumors surgically treated from 1997 to 2009.The clinical and radiographic data were reviewed.The short and long-term follow-up was performed to evaluate the clinical outcome and biomechanical change of the spine.Results Patients were divided into four groups according to the type of laminectomy and the site of lesion：group A：3 laminae removed;group B：≥3 laminae removed;group C：intramedullary lesions and group D extramedullary lesions.The period of follow-up ranged from 3 months to 12 years.The incidence of cervical spinal instability during the follow-up period was 3.1% in group A,and 16.7% in group B（P0.1）,36.4% in group C,and 4.3% in group D（P0.1）.The incidence of worsen of cervical curvature was found to be 3.1% in group A,23.3% in group B（P0.1）;45.5% in group C,6.4% in group D（P0.1）.Conclusions Laminectomy has the tendency of influencing the biomechanical stability of cervical spine.Postoperative instability or deformity should be kept in mind when ≥3 laminae were removed,intramedullary lesions presented or both dentata and vertebra prominens were involved.

关 键 词：椎管内肿瘤 椎板切除术 显微外科手术 脊柱稳定性 

分 类 号：R687.3[医药卫生—骨科学]