旋转椎弓法显露椎管并回植在椎管内良性肿瘤切除术中的应用  

Application of the rotational arch method of revealing the spinal canal and implanting back in resection of benign intravertebral tumors

作　　者：周英杰 王彦金 禚汉杰 柴旭斌 徐铖菡 郝宇鹏 Zhou Yingjie;Wang Yanjin;Zhuo Hanjie;Chai Xubin;Xu Chenghan;Hao Yupeng(Department of Spinal Surgery,Luoyang Orthopaedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopaedic Hospital),Luoyang 471002,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)脊柱外科,洛阳471002

出　　处：《中华骨科杂志》2024年第10期669-675,共7页Chinese Journal of Orthopaedics

基　　金：中医药传承与创新人才工程(仲景工程)项目。

摘　　要：目的探讨旋转椎弓法显露椎管并回植在椎管内良性肿瘤切除术中的有效性和安全性。方法回顾性分析2017年4月至2022年10月于河南省洛阳正骨医院接受旋转椎弓法显露椎管并回植联合肿瘤切除的胸腰椎椎管内良性肿瘤患者17例,男9例、女8例,年龄(58.59±13.57)岁(范围29~75岁)。胸椎椎管内肿瘤7例、胸腰段椎管内肿瘤2例、腰椎椎管内肿瘤8例;手术节段为单节段6例、双节段8例、三节段3例。病程(20.35±16.58)个月(范围3~60个月)。组织病理学:神经鞘瘤9例、脊膜瘤5例、畸胎瘤2例、皮样囊肿1例。记录手术时间、术中出血量,观察术后椎管容积、内固定稳定性及椎板愈合情况。比较手术前后Cobb角、美国脊柱损伤协会(American spinal injury association,ASIA)分级和Oswestry功能障碍指数(Oswestry disability index,ODI)的改善情况。结果17例患者均顺利完成手术并获得随访,随访时间为(10.5±2.4)个月(范围6~20个月)。手术时间(156.76±26.81)min(范围120~210 min),术中出血量(338.24±97.68)ml(范围200~600 ml)。术中无一例出现神经及血管损伤,1例因用力过度造成棘突不完全骨折,未特殊处理,术后随访愈合良好。术后引流量(147.06±31.58)ml(范围100~210 ml)。患者术前局部Cobb角为14.15°±6.58°,术后为14.73°±6.34°,差异无统计学意义(t=1.810,P=0.089)。患者术前ODI为63.65%±6.57%,末次随访降低至23.88%±4.21%,差异有统计学意义(t=53.359,P<0.001)。17例患者术前ASIA分级B级2例、C级9例、D级6例,末次随访时ASIA分级B级1例、C级4例、D级8例、E级4例,较术前明显改善,差异有统计学意义(Z=2.587,P=0.010)。所有患者切口均Ⅰ期愈合,无一例发生脑脊液漏、硬膜外血肿等并发症。术后6个月脊柱三维CT示无一例发生椎板移位、内固定松动、感染及断裂。结论旋转椎弓法显露椎管并回植联合肿瘤切除治疗椎管内良性肿瘤术后神经功能恢复良好,并发症�Objective To investigate the efficacy and safety of the rotational arch method of revealing the spinal canal and implanting back in resection of benign intravertebral tumours.Methods A total of 17 patients with benign intravertebral tumors of the thoracolumbar spine who underwent a rotational arch method of revealing the spinal canal and implantation back in combination with tumor resection in Luoyang Orthopaedic-Traumatological Hospital of Henan Province from April 2017 to October 2022 were retrospectively analyzed.There were 9 males and 8 females,aged 58.59±13.57 years(range,29-75 years).There were 7 cases of thoracic intravertebral tumors,2 cases of thoracolumbar intravertebral tumors,and 8 cases of lumbar intravertebral tumors.The operated segments were 6 cases of single-segment,8 cases of double-segment,and 3 cases of triple-segment.The disease duration was 20.35±16.58 months(range,3-60 months).Histopathology showed 9 cases of schwannoma,5 cases of meningioma,2 cases of teratoma,and 1 case of dermoid cyst.The operation time,intraoperative blood loss,postoperative spinal canal volume,stability of internal fixation,and lamina healing were recorded.The Cobb angle,American Spinal Injury Association(ASIA)classification and Oswestry disability index(ODI)were compared before and after operation.Results All patients were successfully operated and followed up for an average of 10.5±2.4 months(range,6-20 months).The operation time was 156.76±26.81 min(range,120-210 min)and intraoperative bleeding was 338.24±97.68 ml(range,200-600 ml).There was no neurovascular injury during the operation.Incomplete spinous process fracture occurred in 1 case due to excessive exertion,which healed well without special treatment.Postoperative drainage volume was 147.06±31.58 ml(range,100-210 ml).The patient's local Cobb angle was 14.15°±6.58°preoperatively and 14.73°±6.34°postoperatively,with no statistically significant difference(t=1.810,P=0.089).The patient's ODI was 63.65%±6.57%preoperatively and decreased to 23.88%±4.

关 键 词：椎管 肿瘤 椎板成形术 

分 类 号：R739.42[医药卫生—肿瘤]