全椎板截骨回植联合“工”型钛板在椎管内肿瘤运用疗效评价  

Evaluation of the Effect of Total Laminectomy and Replantation Combined with H-shaped Titanium Plate in the Treatment of Intraspinal Tumors

作　　者：段亮[1] 时亮[1] 段大鹏[1] 祁洁[1] 弓立群[1] 范亚一[1] 何涛 赵伟 徐洪海[1] Duan Liang;Shi Liang;Duan Dapeng(Deptartment of Orthopaedics,People's Hospital of Shanxi,Xi’an710068,China)

机构地区：[1]陕西省人民医院骨科,陕西西安710068

出　　处：《实用骨科杂志》2019年第5期393-396,共4页Journal of Practical Orthopaedics

基　　金：陕西省科技统筹创新工程计划项目(2015KTCL-03-02)

摘　　要：目的评价全椎板截骨回植联合"工"型微钛板固定及生物膜覆盖运用于椎管内肿瘤的临床疗效。方法分析我院2011年6月至2018年8月收治的9例初发椎管内肿瘤切除(髓外硬膜下)+全椎板截取+椎板原位回植"工"型钛板固定术+生物膜覆盖于硬脊膜的临床资料,其中男6例,女3例;年龄32～75岁,平均年龄(48±6)岁。统计术前及术后Oswestry功能障碍指数(oswestry disability index,ODI)、视觉模拟评分(visual analogue scale,VAS)、椎管内肿瘤改良Mccormick评分(modified mccormick scale,MMS)、硬膜外纤维化(epidural fibrosis,EF)、相邻节段退变(adjacent segment degeneration,ASD)、脑脊液漏并发症发生率、影像学回植椎板愈合率及肿瘤复发率。结果 9例均获1年或1年以上随访,术后末次ODI、VAS、MMS评分显著优于术前(P<0.05)。围手术期无一例脑脊液漏发生。回植截骨部CT均显示骨性愈合,未见钛板螺钉的松动及断裂。未发现硬膜外纤维化及邻近节段退变的发生。结论全椎板截骨回植联合"工"型钛板固定及生物膜覆盖治疗椎管内肿瘤,对于降低硬膜外纤维化、减少术后脑脊液漏、减少相邻节段退变、维护脊柱稳定性疗效显著,是治疗椎管内肿瘤的有效术式。Objective To evaluate the clinical efficacy of total laminectomy and replantation combined with H-shaped microtitanium plate fixation and bio-film covering for intraspinaltumors. Methods 9 cases of initial intraspinal tumor resection (extramedullary subdural) underwent total laminectomy and laminectomy with plate fixation and biofilm coverage of the dura materin situ in our hospital from June 2011 to August 2018.There were 6 males and 3 females,aged from 32 to 75 years,with an average age of (48±6)years.We recorded preoperative and postoperative ODI,VAS,MMS score,epidural fibrosis (EF),adjacent segment degeneration (ASD),the incidence of cerebrospinal fluid leakage complications,imaging replantation laminar healing rate and tumor recurrence rate. Results All 9 patients were followed up for 1 year or more.The final ODI,VAS scores were significantly better than those before surgery ( P < 0.05).There was no case of cerebrospinal fluid leakage during perioperative period.The CT of the replanted osteotomy showed bone healing,and no loosening or fracture of the titanium plate screw was observed.No epidural fibrosis and adjacent segment degeneration occurred. Conclusion Total laminectomy and replantation combined with H-shaped titanium plate fixation and biofilm coverage for treatment of intraspinal tumors can reduce epidural fibrosis,reduce postoperative cerebrospinal fluid leakage,reduce adjacent segment degeneration,and maintain spinal stability.It is an effective procedure for the treatment of intraspinal tumors.

关 键 词：全椎板截骨 回植 “工”型钛板 椎管内肿瘤 疗效评价 

分 类 号：R739.42[医药卫生—肿瘤]