椎板成形术治疗原发性胸腰椎椎管内肿瘤临床分析  

Clinical research of laminoplasty for primary thoracolumbar intraspinal tumors

作　　者：杨大志[1] 王敏[1] 王尔天[1] 易伟宏[1] 

机构地区：[1]广东医学院附属南山医院脊柱外科,深圳518052

出　　处：《临床外科杂志》2016年第6期467-469,共3页Journal of Clinical Surgery

基　　金：广东省自然科学基金资助项目(S2012010008531;2015A030313877);深圳市科技创新委资助项目(CXZZ20130516151903472;JCYJ20140411094549460)

摘　　要：目的分析椎板回植成形术在原发性胸腰椎椎管内肿瘤切除手术中的价值。方法原发性胸腰椎椎管内肿瘤患者21例,术中切断双侧椎板,保留双侧关节突,完整取下棘突椎板复合体,显微镜下摘除肿瘤后将棘突椎板复合体原位回植。并用椎弓根螺钉固定,丝线修复棘突间韧带。术后椎管矢状径、椎板融合率、日本骨科学会(Japanese orthopaedic association,JOA)评定进行效果评定。结果椎管内肿瘤成功切除,未出现脑脊液漏,无顽固性下腰痛,术后1年JOA评分由术前(11.4±2.6)分上升至(24.7±3.3)分,差异有统计学意义(P<0.05),术后优良率达82.5%,术前椎管矢状径为(13.5±1.5)mm,随访6月后术后椎体CT显示椎管矢状径为(16.4±2.4)mm,术后1年椎板骨性融合率90.48%。结论原发性胸腰椎椎管内肿瘤切除手术中,椎板回植成形术法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 application value of recapping laminoplasty for primary thoracolumbar intraspinal tumors. Methods From October 2010 to March 2015,21 patients with primary thoracolumbar tumor were enrolled. During the procedure, bilateral vertebral plates were cut off and the articular processes were preserved to obtain the complex of spinous process and vertebral plate. After the mi- croscopic resection for tumors, the complex was replanted back to the in-situ position and then reconstruc- ted with pedicle screw fixation and ligament suture. Postoperative sagittal diameter of the vertebral canal, lamina fusion rate, and the Japanese orthopedics association （JOA） score were used for evaluation. Re- sults All tumors were successfully resected without complications such as cerebrospinal fluid leakage or intractable low-back pain. After the operation, the JOA score of the first year was increased from （ 11.4 _＋ 2.6） points to （24.7 ＋ 3.3 ） points and the difference was statistically significant （P 〈 0. 05 ）. The post- operative excellent and good rate was 82. 5%. The sagittal diameter the spinal canal increased from （13.5 ±1.5） mm to （16.4 ± 2.4） mm at the sixth month after operation. The fusion rate reached 90. d,8 % at the first year after operation. Conclusion For primary thoracolumbar intraspinal tumor,recapping laminoplasty could rebuild the anatomical structure of the spine, and maintain the spinal stability.

关 键 词：椎管肿瘤 腰椎 显微外科手术 椎板回植 

分 类 号：R739.42[医药卫生—肿瘤]