超声骨刀联合硫酸钙人工骨植入在腰椎管肿瘤手术中的应用  

Laminoplasty by Piezosurgery and Artificial Bone Graft with Calcium Sulfate within Lumbar Intraspinal Tumors

作　　者：史良[1] 阎涛[1] 王汉斌[1] 王科大[1] 刘龙奇 苏亦兵[1] Shi Liang;Yan Tao;Wang Hanbin;Wang Keda;Liu Longqi;Su Yibing(Department of Neurosurgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院神经外科,北京100035

出　　处：《实用骨科杂志》2022年第3期193-197,共5页Journal of Practical Orthopaedics

基　　金：北京市属医院科研培育项目(PX2020018);北京积水潭医院学科骨干培养计划(XKGG202115);北京积水潭医院医工企交叉培育项目(YGQ-201906)。

摘　　要：目的探讨在腰椎椎管内肿瘤切除术中,使用超声骨刀行棘突椎板复合体切除及回植并植入硫酸钙人工骨的应用价值。方法回顾分析了2018年1月至2021年1月79例腰椎椎管内肿瘤的患者,其中男46例,女33例;年龄21~78岁,平均(39.8±14.7)岁。在使用超声骨刀棘突椎板回植的基础上,行硫酸钙人工骨植入的方法,重建脊柱解剖结构,观察术中椎板棘突复合体切除及回植所用时间、手术时间、手术出血量,并随访观察患者的相关并发症、影像学变化及及骨质融合情况。结果79例患者使用超声骨刀平均切开(1.7±0.7)个椎体,除1例硬膜破损外,其余未见硬脊膜破损、脊髓和神经根损伤等并发症。手术时间平均(124.8±21.7)min,平均每个椎体切开所需用时(8.2±2.8)min,平均回植所用时间(6.7±2.9)min;术中平均失血(276.1±69.7)mL;术后患者平均(12.5±3.0)d可痊愈出院。随访时间6~18个月,平均(9.7±3.5)个月,CT及MRI见棘突椎板复合体愈合良好,未见移位、塌陷,钛板及钛钉松动、断裂等现象,硫酸钙人工骨降解吸收,53例(67.1%)可见骨质缺损区硬化带形成。结论采用超声骨刀的棘突椎板复合体切开回植并硫酸钙人工骨植入的手术方式,操作安全可靠,棘突椎板复合体回植率及骨性愈合率明显提高,值得临床进一步推广应用。Objective To evaluate piezosurgery and artificial bone graft with Calcium Sulfate during recapping laminoplasty in the operation of lumbar intraspinal tumors.Methods We reviewed 79 patients with lumbar intraspinal tumor from Jan 2018 to Jan 2021,including 46 males and 33 females, aged from 21 to 78 years old, with an average age of(39.8±14.7)years, who underwent operations using piezosurgery and artificial bone graft with Calcium sulfate to recap laminoplasty.We analyzed all of surgical data, including the amount of surgical blood loss, the duration of operation and recapping laminoplasty.The therapeutic outcome were assess by the complications, imaging changes and bone fusion postoperatively.Results In the 79 cases,(1.7±0.7)vertebrae were dissected by piezosurgery, and no complications such as dural matter tear, neurovascular injury were observed except 1 case of dural rupture.The mean intraoperative blood loss was(276.1±69.7)mL,and the duration of operation was(124.8±21.7)min.About each vertebral body, the laminectomy took averagely(8.2±2.8)min and replantation was(6.7±2.9)min.The postoperative recovery was(12.5±3.0)days.The mean follow-up time was(9.7±3.5)months.MRI and CT showed good alignment of the spinous process lamina complex, without displacement, collapse, and other spinal-stenosis phenomena.The calcium sulfate was absorbed, and sclerotic zone around bone defect area were confirmed in 53 cases(67.1%).Conclusion Replantation of the spinous process and lamina complex using ultrasonic bone curette and bone graft with Calcium Sulfate in the resection of lumber spinal cord tumors is safe and reliable, which is conductive to the bone graft fusion and promising outcomes.

关 键 词：超声骨刀 椎板成形术 硫酸钙 腰椎 椎管内肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]