应用后路钛网椎管成形术治疗胸椎椎管内肿瘤  

The treatment of thoracic intraspinal tumor surgery by posterior lamina reconstruction with titanium rete

作　　者：张立[1] 赵敏[1] 周江军[1] 朱治宇[1] 吕仁发[1] 张懿城[1] 

机构地区：[1]解放军第184医院骨科,鹰潭335000

出　　处：《中国骨与关节杂志》2012年第4期354-357,共4页Chinese Journal of Bone and Joint

摘　　要：目的椎管内肿瘤全椎板减压术是椎管内肿瘤摘除的常规手术方式,术后易造成椎管内粘连导致椎管再次狭窄引起一系列的并发症,造成2次手术困难,本文对这一术式进行改良,采用后路钛网椎管成形对所减压的椎管进行修复重建,恢复椎管内有效容积、减少粘连。方法 2007年10月至2011年2月共收治9例胸椎椎管内肿瘤的患者,男6例,女3例,年龄25～64岁,平均37.8岁。硬膜外肿瘤5例,硬膜内肿瘤4例。全部给予后路全椎板减压,肿瘤切除,椎弓根钉内固定并钛网椎管成形术。术后病理学诊断:神经鞘瘤3例,脊膜瘤2例,脂肪瘤2例,囊肿2例。肿瘤复发1例,给予2次手术切除后未复发。结果手术时间90-185min,平均142min,失血量200～1200ml,平均521ml,全部9例患者术后得到定期随访12-45个月,平均21个月。采用Frankel评分标准对术后患者症状进行评价,A:0例,B:1例,C:3例,D:2例,E:3例。术后复发1例。术后CT显示椎管内未出现粘连。对术前术后肿瘤占位所在节段椎管横截面CT图片进行分析,每例患者随机取5个横截面进行椎管内矢状径测量,取平均值,术前矢状径为16.89±1.27mm,术后矢状径为27.11±2.52mm,进行配对t检验,t=-15.441,P<0.01,术后椎管矢状径明显大于术前。结论后路钛网椎管成形手术难度相对较低,减少手术时间,降低术中出血量,术后对椎管起到较好的即刻保护作用,同时增加了术后椎管容积,减少了术后粘连,为肿瘤复发后的2次手术剥离减少风险。Objective Total laminectomy decompression is the most common surgical method for the removal of intraspinal tumors. However, postoperatively it always leads to intraspinal conglutination and spinal stenosis again, and further causes a series of complications, which would make it difficult to perform the second operation. This paper aims to improve this method, and use the posterior titanium rete vertebral canaloplasty to restore and reconstruct the decompressed spinal canal, recover the effective volume of the spinal canal, and reduce conglutination. Methods From October 2007 to February 2011, 9 patients with thoracic intraspinal tumors were adopted, including 6 males and 3 females, whose average age was 37.8 years old （range; 25-64 years）. 5 cases were of epidural tumors, and 4 cases were of intradural tumors. All patients were treated by total posterior laminectomy decompression, internal fixation with pedicel screws and titanium rete vertebral canaloplasty. The pathological examination after surgery showed that 3 cases were of schwannoma, 2 cases were of meningioma, 2 cases were of lipoma and 2 cases were of cyst, 1 patient was treated by the second operation due to recurrence, and got recovered after surgical resection. Results The operation time ranged from 90 to 185 minutes, with an average period of 142 minutes, and the blood loss ranged from 200 to 1200ml, with an average amount of 521ml. All 9 patients were followed up for a mean period of 21 months （range; 12-45 months）. According to Frankel criteria, the postoperative clinical outcomes were A in 0 case, B in 1 case, C in 3 cases, D in 2 cases and E in 3 cases. Postoperative recurrence occurred in 1 cases. The CT showed no intraspinal conglutination after surgery. The CT images of spinal canal cross-sectional area with tumors were analyzed preoperatively and postoperatively. The sagittal diameters of 5 cross sections taken in each case at random were measured, and the mean value was calculated. The sagittal diameters before and after surgery wer

关 键 词：钛网 椎管成形 胸椎肿瘤 椎管重建 

分 类 号：R738.1[医药卫生—肿瘤]