小儿椎管内肿瘤显微切除术中的椎管重建  

Laminectomy and total reconstruction of the posterior spinal canal by microsur gery for intraspinal tumor in children

作　　者：杨普[1] 钟桂午[1] 武铁[1] 王宗义[1] 闫毅[1] 周凤金[1] 于杰[1] 高炳糁[1] 

机构地区：[1]中国人民解放军第四五一医院神经外科,西安710054

出　　处：《中华小儿外科杂志》2003年第4期332-334,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　探讨小儿椎管内肿瘤显微切除术中保留椎板棘突重建椎管后部结构的手术方法 ,以求避免椎板切除术后并发症发生。方法　自 1 997年 1月～ 2 0 0 2年 3月笔者采用保留和重建椎板后部结构进行椎管内肿瘤切除 9例 ,男 6例 ,女 3例 ,年龄 2 .5～ 1 0岁 ,平均年龄 8.5岁 ,病程 1～ 5年。采用保留带蒂椎板棘突 (6例 )或游离椎板棘突复合体 (3例 ) ,经棘突椎板截骨取下椎管后部 ,形成椎板骨窗 ,显微切除椎管内肿瘤后 ,再将后部结构原位回植固定重建椎管。结果　 9例经MRI诊断证明的椎管内肿瘤 ,颈段 2例 ,胸段 3例 ,腰骶段 4例。 6例采用保留带蒂椎板棘突重建椎管后部 ,3例采用游离椎板棘突重建椎管后部。椎板切开数 1～ 4个 ,平均 2 .5个 ,随访 3个月～ 5年 ,全部患儿在 3个月复查X线见到良好的骨性愈合 ,脊椎序列正常 ,未见骨不愈合和椎板棘突复合体移入椎管倾向 ,无一例脊柱畸形和椎体滑脱者。 6例复查MRI ,见肿瘤切除完全 ,未见椎管狭窄及神经根粘连。结论　小儿椎管内肿瘤显微切除后重建椎管后部 ,可达到保持脊柱正常结构完整 ,避免椎板切除后脊柱变形 。Objective To review the reconstructive methods of the posterior spinal canal with microsur gery in intraspinal tumor and minimize postoperative complication in children. Methods From Jan.1997 to March 2002, 9 cases (male 6, fe male 3) with intraspinal tumor who underwent vertebral laminae and spinal proce ss with/without ligment pedicle removal prior to resection and posterior spinal canals reconstruction. The age ranged from 2,5 to 10 years with an average of 8.5 years. The course was 1～5 years. Results The tumors were located in the cervical in 2 case s, in the thoracic in 3 and in lumbar spinal canal in 5. The posterior spinal ca nal of 6 patients were reconstructed by re-plantation of lamina and spinal process with ligment pedicle, three patients had replantation of free lamina an d spinal process. The number of vertebral lamina incision was 1～4 (mean 2.5 ). All patients were followed-up from 3 months to 5 years. X-ray examinatio n were performed on all patients and MRI was performed on 6 cases. The results showed that spinal alignment was in normal without any complications. Conclusions Microsurgical resection of intraspinal tumor with total reconstruction of the posterior spinal canal in children is a reliable method. It preserves the skeletal structure and prevents spinal deformity formation.

关 键 词：小儿 椎管内肿瘤 显微切除术 椎管重建 椎板棘突复合体 

分 类 号：R726.5[医药卫生—儿科]