【摘要】：目的 :探討椎管內(nèi)腫瘤切除術(shù)中應(yīng)用棘突椎板復(fù)合體回植+空心釘重建脊柱后柱結(jié)構(gòu)的臨床療效。方法:2011年2月~2015年10月,對31例原發(fā)性椎管內(nèi)腫瘤患者行腫瘤切除術(shù),并應(yīng)用棘突椎板復(fù)合體回植聯(lián)合空心釘置入重建脊柱后柱結(jié)構(gòu)。其中26例患者獲得隨訪,男11例,女15例,年齡29~76歲(46.5±8.4歲)。所有隨訪的患者均行X線、CT檢查觀察脊柱穩(wěn)定性及椎管成形情況,MRI檢查評價腫瘤的切除情況,術(shù)后采用日本骨科學(xué)會(Japanese orthopaedic association,JOA)評定法進行效果評定。結(jié)果:成功置入64枚空心螺釘,手術(shù)時間為75~148min(96±21min),術(shù)中出血量為170~305ml(225±32ml),4例出現(xiàn)腦脊液漏,未出現(xiàn)脊髓損傷、感染等相關(guān)并發(fā)癥。隨訪6~28個月(13.5±2.1個月),術(shù)后動力位X線片提示脊柱活動度基本得以保留,無椎體失穩(wěn)或滑脫;末次隨訪CT評估發(fā)現(xiàn)2個節(jié)段的空心螺釘累及關(guān)節(jié)突關(guān)節(jié),沒有觀察到螺釘斷裂或位移現(xiàn)象,20例(76.9%)患者達到骨性愈合;MRI示腫瘤無復(fù)發(fā);腰椎JOA評分從術(shù)前11.2±2.1分升至末次隨訪時的24.6±2.8分,差異有統(tǒng)計學(xué)意義(P0.05),優(yōu)良率達80.8%。結(jié)論:原發(fā)性椎管內(nèi)腫瘤切除術(shù)中應(yīng)用空心釘固定棘突椎板復(fù)合體可以有效重建脊柱后柱結(jié)構(gòu),固定可靠,能有效避免術(shù)后醫(yī)源性椎管狹窄,是治療椎管內(nèi)腫瘤的有效術(shù)式。
[Abstract]:Objective: to investigate the clinical effect of replantation of posterior column of spinal column with spinous process laminar complex in intraspinal tumor resection. Methods: from February 2011 to October 2015, 31 patients with primary intraspinal tumors were treated with tumor resection, and the posterior column structure was reconstructed with spinous process laminar complex replantation and hollow nail implantation. Among them, 26 patients were followed up, 11 males and 15 females, aged 2976 (46.5 鹵8.4 years). All the patients were followed up by X-ray CT to observe the stability of spine and spinal canal formation and MRI to evaluate the resection of tumor. The effect was evaluated by (Japanese orthopaedic association (JOA) method of Japanese Orthopaedic Association after operation. Results: 64 hollow screws were successfully implanted, the operative time was 75~148min (96 鹵21min), and the intraoperative bleeding volume was 170~305ml (225 鹵32ml). Cerebrospinal fluid leakage occurred in 4 cases, no spinal cord injury, infection and other related complications. Follow-up for 6 to 28 months (13.5 鹵2.1 months) showed that the motion of the spine was basically preserved and there was no instability or slippage of the vertebral body, and two hollow screws involving the articular facet joints were found in the last follow-up. No screw breakage or displacement was observed in 20 patients (76.9%). MRI showed no recurrence, JOA score of lumbar vertebrae increased from 11.2 鹵2.1 before operation to 24.6 鹵2.8 at the last follow-up, the difference was statistically significant (P0.05), and the excellent and good rate was 80.8%. Conclusion: the hollow nail fixation of spinous process laminar complex in primary intraspinal tumor resection can effectively reconstruct the posterior column structure of the spinal column, and can effectively avoid postoperative iatrogenic spinal canal stenosis. It is an effective method for the treatment of intraspinal tumors.
【作者單位】： 福建醫(yī)科大學(xué)附屬南平第一醫(yī)院脊柱外科;
【基金】：福建省南平市科技項目基金項目(編號:N2015Y03)
【分類號】：R739.42

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