改良棘突椎板复合体回植治疗原发性腰椎管内肿瘤  

Treatment of primary intraspinal canal tumors with modified replantation of the spinous process and lamina complex

作　　者：柯荣军[1] 许福生[1] 陈建民[2] 刘方刚[1] 祁伟[1] 曹华[1] 刘静[1] 顾永福[1] 

机构地区：[1]解放军第三五九医院骨科,镇江212001 [2]解放军第八一医院骨科,南京210002

出　　处：《中国骨与关节杂志》2015年第7期561-563,共3页Chinese Journal of Bone and Joint

摘　　要：目的探讨原发性腰椎管内肿瘤切除手术中使用改良棘突椎板复合体回植的方法和效果。方法回顾2010年1月至2013年1月,我院收治的24例原发性腰椎管内肿瘤患者,术中用微型磨锯切断双侧椎板,保留双侧关节突,切断一侧棘上和棘间韧带,临时固定于一端,显微镜下摘除肿瘤,将带蒂棘突椎板复合体原位回植,选取微型钛板固定。术后采用影像学检查以及日本骨科学会(Japanese orthopaedic association,JOA)评定法进行效果评定。结果所有患者肿瘤成功切除,未出现脑脊液漏,无顽固性下腰痛,钛板固定可靠,回植椎板无塌陷,能有效融合。术后2年JOA评分由术前平均(11±2.6)分上升至(24±3.3)分,差异有统计学意义(P<0.05),术后优良率达83.3%。结论原发性腰椎管内肿瘤手术中应用改良带蒂棘突椎板复合体回植安全、有效,方法简单,重建了脊柱的解剖结构,维持了术后脊柱的稳定性。Objective To investigate the surgical outcomes in the treatment of primary intraspinal canal tumors with modified replantation of the spinous process and lamina complex.Methods From January 2010 to January 2013,24 patients with primary intraspinal canal tumors were included in this retrospective study.During the operation,bilateral vertebral plates were removed by a mini electric saw,with bilateral facet joints reserved.The supraspinal and interspinal ligaments were cut off,and were temporarily fixed on one side.After the resection of intraspinal tumors under the microscope,the spinous process and lamina complex was replanted in situ and was fixed by titanium miniplates.Postoperative imaging examination and Japanese orthopaedic association（ JOA） scoring system were used to evaluate the clinical outcomes.Results The tumors in all the patients were successfully resected without complications such as cerebrospinal fluid leakage or obstinate low back pain.In each case,the fixation by titanium miniplates was stable and a solid fusion was achieved.No collapse of the replanted lamina was observed.The JOA score was increased from（ 11±2.6） points preoperatively to（ 24±3.3） points at 2 years after the operation,and the differences were statistically significant（ P〈0.05）.The postoperative excellent and good rate was 83.3%.Conclusions The modified replantation of the spinous process and lamina complex in the surgical treatment of primary intraspinal canal tumors is safe and effective.This simple method can reconstruct the anatomic structure of the spine and maintain the spinal stability.

关 键 词：脊髓肿瘤 腰椎 椎管 外科手术 显微外科手术 棘突椎板复合体 

分 类 号：R739.42[医药卫生—肿瘤]