微钛板内固定椎管重建技术在儿童椎管内先天性肿瘤切除术中的应用  

Application of micro-titanium plate internal fixation technique for spinal canal reconstruction in children undergoing congenital spinal tumor resection

作　　者：李涛[1] 裴航 吕强[1] 齐林[1] Li Tao;Pei Hang;Lyu Qiang;Qi Lin(Department of Neurosurgery,Children′s Hospital Affiliated with Zhengzhou University(Henan Children′s Hospital,Zhengzhou Children′s Hospital),Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院(河南省儿童医院,郑州儿童医院)神经外科,郑州450000

出　　处：《中华神经外科杂志》2022年第5期482-486,共5页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划(2018020671)。

摘　　要：目的初步观察微钛板内固定椎管重建技术在儿童椎管内先天性肿瘤切除术中的应用效果。方法回顾性分析2013年1月至2016年12月郑州大学附属儿童医院神经外科在肿瘤切除术中采用微钛板内固定椎管重建技术治疗的46例椎管内先天性肿瘤患儿的临床资料。分别于出院后第1、3、6及12个月进行门诊随访,第2年开始每年复查1次。复查时行脊柱螺旋CT三维重建及MRI检查。采用改良McCormick分级标准评估临床症状。采用White-Panjabi影像学评分标准评估脊柱稳定性,以评分≥5分为脊柱失稳。分别测量手术前、后的颈、胸、腰椎各手术节段椎管的横径和前后径,并进行手术前、后的比较,以评估是否造成椎管狭窄。结果46例患儿术中游离椎板节段数为(4.0±1.1)个(2~7个),手术椎管共184个节段,包括61个颈椎节段、91个胸椎节段以及32个腰椎节段,手术时长为(102.4±15.2)min(60~130 min)。术后均无感染、脑脊液漏、脊髓或神经根损伤等并发症。46例患儿的随访时间为(24.7±5.3)个月(12~36个月)。术后1年改良McCormick分级Ⅰ级30例,Ⅱ级12例,Ⅲ级3例,Ⅳ级1例,较术前改善,差异有统计学意义(P=0.009)。末次随访时无一例出现脊柱失稳。184个手术节段的术后椎管横径和前后径与术前比较,差异均无统计学意义(均P>0.05)。结论椎管内先天性肿瘤切除术中采用微钛板内固定椎管重建技术的患儿术后临床症状改善、并发症少,术后脊柱稳定性好。Objectives To observe the application effect of spinal canal reconstruction with micro-titanium plate internal fixation in children undergoing congenital spinal canal tumor resection.Methods This study retrospectively analyzed the clinical data of 46 children with congenital spinal tumors treated by spinal canal reconstruction technique with micro-titanium plate internal fixation during tumor resection in the Department of Neurosurgery,Children′s Hospital Affiliated with Zhengzhou University from January 2013 to December 2016.Outpatient follow-up was performed at 1,3,6 and 12 months after discharge,and annual review was conducted since the second year post operation.Three-dimensional spiral CT reconstruction and MRI were performed during the review.Clinical symptoms were assessed using the modified McCormick grading standard to assess the efficacy.Spinal stability was assessed by the White-Panjabi criterion,and spinal instability was defined as the score of at least 5.The transverse and anteroposterior diameters of the spinal canal of cervical,thoracic and lumbar vertebrae were measured before and after surgery,and were compared before and after surgery to evaluate whether spinal canal stenosis occurred.Results In 46 cases,there were 2-7 segments of free lamina,with an average of 4.0±1.1 segments.A total of 184 spinal canal segments were operated on,including 61 cervical vertebra segments,91 thoracic vertebra segments and 32 lumbar vertebra segments.The operation time was 60-130 min,with an average of 102.4±15.2 min.There were no postoperative complications such as infection,cerebrospinal fluid leakage,spinal cord or nerve root injury.The follow-up time of 46 cases was 12-36 months,with an average of 24.7±5.3 months.One year after operation,there were 30 cases of modified McCormick gradeⅠ,12 cases of gradeⅡ,3 cases of gradeⅢ,and 1 case of gradeⅣ.The grading results were improved compared with those before operation,and the difference was statistically significant(P=0.009).None of the patients had spi

关 键 词：椎板切除术 儿童 治疗结果 椎板成形术 椎管内肿瘤 

分 类 号：R739.42[医药卫生—肿瘤]