本文關(guān)鍵詞： 椎管腫瘤 椎管重建 手術(shù) 脊柱畸形　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討椎管內(nèi)腫瘤切除術(shù)中回納椎板-棘突復(fù)合體對手術(shù)效果的影響。方法:回顧性分析我院2014年1月至2016年3月行椎管內(nèi)腫瘤手術(shù)患者的臨床資料,其中重建組40例,男16例,女24例,年齡12-80歲,平均年齡49±17歲;非重建組65例,男31例,女34例,年齡14-79歲,平均年齡47±16歲。兩組患者術(shù)前均行MRI平掃及增強明確椎管內(nèi)病變的位置及腫瘤所在節(jié)段的精確定位,部分患者行相應(yīng)節(jié)段椎管CT三維重建,所有患者術(shù)前均無脊柱畸形。術(shù)前所有患者均出現(xiàn)不同程度的脊髓或神經(jīng)根受壓、刺激癥狀。兩組患者術(shù)前均行脊柱正側(cè)位X線片并使用亞甲藍(lán)精確定位,氣管插管下全麻取俯臥位,非重建組采用傳統(tǒng)的全椎板切除手術(shù)方法,腫瘤切除后棄去棘突、骨板及后部韌帶復(fù)合體;重建組使用微型磨鉆或銑刀將椎板-棘突復(fù)合體完整取下,切除腫瘤后將其回納以重建椎管的解剖結(jié)構(gòu)。采用Mc Cormic評分標(biāo)準(zhǔn)對患者術(shù)前、術(shù)后一周及末次隨訪的神經(jīng)功能狀態(tài)進(jìn)行評價;術(shù)后定期行MRI/三維CT重建,了解有無脊柱畸形,并以Cobb角10o視為脊柱不穩(wěn);同時比較兩種不同手術(shù)方式對術(shù)后平均住院時間、臥床時間及腦脊液漏等并發(fā)癥的影響。結(jié)果:椎管重建組平均手術(shù)時間為156±35min,非重建組為165±34min;椎管重建組腫瘤全切35例,次全切5例,非重建組全切53例,次全切12例;椎管重建組中硬膜外、髓外硬膜下及髓內(nèi)腫瘤分別是5例、30例、5例,非重建組分別是7例、44例、14例;椎管重建組病理類型以神經(jīng)鞘瘤最常見為18例,其次為脊膜瘤8例、皮樣囊腫6例、室管膜瘤4例、脂肪瘤2例、海綿狀血管瘤2例,非重建組中神經(jīng)鞘瘤32例、脊膜瘤8例、室管膜瘤6例、皮樣囊腫3例、脂肪瘤5例、海綿狀血管瘤7例、畸胎瘤3例、轉(zhuǎn)移瘤1例。重建組術(shù)后平均住院時間及臥床時間分別是11±3d、8±4d,非重建組分別是15±4d、12±5d;重建組與非重建組術(shù)后腦脊液漏分別是1例、10例,經(jīng)保守治療后均痊愈;重建組術(shù)后隨訪7-30個月,非重建組術(shù)后隨訪7-30個月,術(shù)后遠(yuǎn)期神經(jīng)功能恢復(fù)以末次隨訪Mc Cormic評分標(biāo)準(zhǔn)進(jìn)行等級評價,重建組Ⅰ級32例、Ⅱ級7例、Ⅲ級1例,非重建組Ⅰ級37例、Ⅱ級12例、Ⅲ級16例;重建組患者有3例出現(xiàn)術(shù)后脊柱不穩(wěn),非重建組出現(xiàn)脊柱不穩(wěn)15例,其中3例出現(xiàn)以頸背部疼痛為主的臨床癥狀,1例患者因腰椎側(cè)凸在外院行矯正手術(shù)。結(jié)論:椎管內(nèi)腫瘤術(shù)中將椎板-棘突復(fù)合體回納,能在一定程度上保留脊柱的骨性結(jié)構(gòu),重建脊柱后部結(jié)構(gòu)、使之在一定程度上達(dá)到解剖復(fù)位,有效防止椎板去除后因脊柱失去部分骨性組織及韌帶等張力性結(jié)構(gòu)的支撐而發(fā)生脊柱不穩(wěn);椎管重建可縮短術(shù)后平均住院時間,并能早期下床活動,明顯減少術(shù)后的臥床時間;同時可降低術(shù)后腦脊液漏的發(fā)生率、改善患者遠(yuǎn)期神經(jīng)功能狀態(tài)�？傮w而言,椎管重建手術(shù)切除椎管內(nèi)腫瘤是一種安全、有效的手術(shù)方式。
[Abstract]:Objective: to investigate the effect of laminectomy combined with spinous process on the surgical effect in intraspinal tumor resection. The clinical data of patients undergoing intraspinal tumor surgery from January 2014 to March 2016 in our hospital were retrospectively analyzed. There were 40 cases in the reconstruction group, 16 males and 24 females, aged 12-80 years, with an average age of 49 鹵17 years. There were 65 cases in the non-reconstruction group, 31 males and 34 females aged 14-79 years. The mean age was 47 鹵16 years. MRI plain scan and enhancement were performed in both groups before operation to determine the location of intraspinal lesions and precise location of the tumor segment. Some patients underwent CT three-dimensional reconstruction of the corresponding segments of the spinal canal. All the patients had no spinal deformity before operation. All the patients had different degree of spinal cord or nerve root compression and irritation symptoms before operation. Under tracheal intubation, the prone position was taken under general anesthesia. In the non-reconstruction group, the traditional laminectomy method was used, and the spinous process, bone plate and posterior ligament complex were removed after tumor resection. In the reconstruction group, the laminum-spinous process complex was removed completely by using a micro-grinding drill or milling cutter, and the tumor was resected to reconstruct the anatomical structure of the spinal canal. The patients were evaluated with Mc Cormic score before operation. The neurological function was evaluated after one week and one last follow-up. MRI / 3D CT reconstruction was performed regularly after operation to find out if there were spinal deformities and the Cobb angle 10o was regarded as spinal instability. At the same time, the effects of two different surgical methods on postoperative average hospital stay, bed-rest time and cerebrospinal fluid leakage were compared. Results: the average operation time of spinal canal reconstruction group was 156 鹵35 minutes. In non-reconstruction group, 165 鹵34 min; In the spinal canal reconstruction group, there were 35 cases of total tumor resection, 5 cases of subtotal resection, 53 cases of non-reconstruction group and 12 cases of subtotal resection. In the spinal canal reconstruction group, there were 5 cases of extradural, 5 cases of subdural and intramedullary tumors respectively, and 4 cases of non-reconstruction group (7 cases, 44 cases). The pathological types of spinal canal reconstruction group were neurilemmoma (18 cases), meningioma (8 cases), dermoid cyst (6 cases), ependymoma (4 cases), lipoma (2 cases) and cavernous hemangioma (2 cases). There were 32 cases of neurilemmoma, 8 cases of meningioma, 6 cases of ependymoma, 3 cases of dermoid cyst, 5 cases of lipoma, 7 cases of cavernous hemangioma and 3 cases of teratoma. The average hospitalization time and bed rest time were 11 鹵3 days and 8 鹵4 days in the reconstruction group, and 15 鹵4 days and 12 鹵5 days in the non-reconstruction group, respectively. The cerebrospinal fluid leakage in the reconstruction group and the non-reconstruction group was 1 case or 10 cases respectively after conservative treatment. The postoperative follow-up was 7-30 months in the reconstruction group and 7-30 months in the non-reconstruction group. The long-term recovery of nerve function was evaluated by the last follow-up Mc Cormic score. In the reconstruction group, there were 32 cases of grade 鈪，

本文編號：1469837