后路有限椎板切除术治疗胸椎管内髓外肿瘤的疗效分析  

Analysis of curative effect of limited laminectomy for the treatment of thoracic intraspinal extramedullary tumors

作　　者：胡太兵 黄仕光 曾广吾 董时纯 HU Tai-bing;HUANG Shi-guang;ZENG Guang-wu;DONG Shi-chun(Department of Orthopaedics, Guidong People＇s Hospital of Guangxi Zhuang Autonomous Region, Wuzhou 543001, China)

机构地区：[1]桂东人民医院骨科,广西梧州543001

出　　处：《骨科》2018年第3期212-216,共5页ORTHOPAEDICS

摘　　要：目的评价后路有限椎板切除治疗胸椎管内髓外肿瘤的疗效和可行性。方法回顾性分析我院2009年7月至2017年5月收治的85例胸椎管内髓外肿瘤病人的临床资料。采用后入路全椎板切除+椎弓根螺钉内固定术的36例纳入全椎板切除内固定组,采用后入路有限椎板切除、无内固定的49例纳入有限椎板切除组。比较两组病人的手术时间、失血量、住院费用、术后日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗分数、胸椎后凸Cobb角变化、术后脑脊液漏发生率。结果两组术后随访6~36个月,全椎板切除内固定组的平均随访时间为(20.36±8.61)个月,有限椎板切除组的平均随访时间为(21.73±7.33)个月。有限椎板切除组的手术时间为(2.37±0.22)h,失血量为(313.3±32.8)ml,住院费用为(1.63±0.24)万元,均低于全椎板切除内固定组,差异均有统计学意义(t=16.799,t=21.620,t=24.071,P均<0.001);两组的JOA评分优良率、胸椎后凸Cobb角变化、脑脊液漏发生率比较,差异均无统计学意义(χ~2=0.091,t=-0.809,χ~2=0.186,P均>0.05)。结论后路有限椎板切除术治疗胸椎管内髓外肿瘤与全椎板切除内固定术相比,疗效、术后并发症、术后胸椎后凸变化情况相近,但手术时间、术中失血量、住院费用明显低于后者,是一种有效、经济、安全的治疗方法。Objective To evaluate the effect and safety of posterior finite laminectomy for treatment ofthoracic intraspinal-extramedullary tumors. Methods From July 2009 to May 2017, 85 patients withintraspinal extramedullary tumors in our hospital were retrospectively analyzed. There were 36 cases ofposterior laminectomy plus pedicle screw fixation as the total laminectomy and internal fixation group, and 49 cases of posterior limited laminectomy and no internal fixation as the limited laminectomy group. We comparedthe operation time, the blood loss, the hospitalization expense, JOA score after operation and the rate ofcerebrospinal fluid leakage between the two groups. Results The two groups were followed up for 6 to 36 months. The mean follow-up time in total laminectomy and internal fixation group was（20.36±8.61） months, andthat in the limited laminectomy group was（21.73±7.33） months. In the limited laminectomy group, the operativetime was（2.37±0.22） h, the blood loss was（313.3±32.8） ml, and the hospitalization expense was（16 300±2 400）yuan RMB, which were significantly reduced as compared with those in the total laminectomy and internalfixation group（t=16.799, t=21.620, t=24.071, P〈0.001 for all）. There was no significant difference in the JOAscore, the Cobb angle and the rate of cerebrospinal fluid leakage between the two groups（χ2=0.091, t=-0.809,and χ2=0.186, P〈0.05 for all）. Conclusion There is no significant difference in the curative effect, thepostoperative complications and the changes of postoperative thoracic kyphosis between the limitedlaminectomy with the laminectomy and internal fixation for the treatment of thoracic intraspinal extramedullarytumors. However, the limited laminectomy can significantly reduce the operative time, the blood loss and thehospitalization expense, and it is effective, economic and safe for the treatment of thoracic intraspinalextramedullary tumors.

关 键 词：椎管内肿瘤 胸椎 椎板切除术 治疗结果 

分 类 号：R738[医药卫生—肿瘤]