椎管内肿瘤切除术中脊柱稳定性重建方式的选择:单中心5年经验  

Strategies of spine reconstruction for intraspinal tumor removal:a single-center,retrospective analysis of 5 years' experience

作　　者：王颖博[1] 朱军[1] 柳峰[1] 刘鹏[1] 赵建华[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所脊柱外科,重庆400042

出　　处：《第三军医大学学报》2014年第6期537-540,共4页Journal of Third Military Medical University

摘　　要：目的探讨椎管内肿瘤手术治疗中脊柱稳定性重建方式的选择并评价其疗效。方法回顾性分析2008年1月至2012年6月于我科实施椎管内肿瘤切除、重建脊柱稳定性手术的73例患者资料，包括男性39例，女性34例，年龄16-68岁，平均32．7岁。肿瘤完全位于硬膜内38例，其余椎管内肿瘤35例。对完全位于硬膜内的肿瘤，采用棘突椎板韧带复合体回植、微型钛板固定术，其余肿瘤采用椎板部分或全切、椎弓根螺钉内固定、植骨融合术。结果手术时间180-270min，平均210min。失血量300-1200mL，平均660mL。术后随访6-39个月，除1例C2-C3髓内脂肪瘤出现暂时性脊髓功能障碍加重外，其余病例术后未出现医源性脊髓损伤，未出现内固定物松动、切口感染，未见回植组织移位、塌陷及继发椎管狭窄。术后动力位X线片比较棘突椎板回植术后脊柱活动度基本得以保留，椎弓根螺钉内固定术后固定节段脊柱可获牢固融合。结论肿瘤完全位于硬脊膜内者，可经后路整体切除椎板，钛板固定棘突椎板复合体；对于椎间关节稳定性结构已破坏者，给予后路椎弓根螺钉内固定及植骨融合术。Objective To explore the surgical treatment strategies and the evaluation of the therapeu- tic efficacy for spine reconstruction after intraspinal tumor removal. Methods We retrospectively analyzed a series of 73 patients with intraspinal tumor who were treated surgically from January 2008 to June 2012. There were 39 males and 34 females with the average age of 32.7 years ranging from 16 to 68. Completely intradural tumors existed in 38 patients, and tumors in vertebral canal in 35 patients. The patients with completely intra-dural tumors underwent en bloc laminectomy. The spinous process and lamina complex was replanted in situ and fixed by titanium plate after resection of spinal cord tumors. Other patients treated with pedicle screw internal fixation surgery. Results The operation time varied from 180 to 270 rain, with an average of 210 rain. The blood loss varied from 300 to 1 200 mL, with median volume of 660 mL. One patient who suffered from lipomy-oma located at C2 - C3 showed spinal dysfunction. All patients were followed up for 6 to 39 months, during which no malunion, infection, spinal stenosis, displacement or collapse of the replanted tissues, or looseness or shift of internal fixation was observed. By comparing Flexion-extension radiographs, replantation of the spinous process and lamina complex and fixation with titanium plate in the resection of intraspinal tumors kept spinal mobility well. Pedicle screw fixation resulted in an ideal stability. Conclusion Surgical approach of resection of intraspinal tumor should be selected according to the location and whether the tumor causes destruction of theintervertebral joint stability. The completely intradural tumors should be treated by en bloc laminectomy, with spinous process and lamina complex replanted in situ and fixed by titanium plate after resection of intraspinal tumor. When the intervertebral joint stability is destroyed by tumors, the patients should be treated by pedicle screw fixation to restore the stability.

关 键 词：椎管内肿瘤 椎板切除术 内固定术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]