【摘要】：目的通過(guò)對(duì)脊柱區(qū)的解剖明確椎管內(nèi)腫瘤經(jīng)后正中入路切除的解剖層次及暴露范圍。對(duì)比分析經(jīng)半椎板入路與全椎板入路切除椎管內(nèi)腫瘤兩種手術(shù)方法，探討經(jīng)半椎板切除椎管內(nèi)腫瘤的優(yōu)缺點(diǎn)、臨床適應(yīng)癥、臨床療效以及對(duì)脊柱穩(wěn)定性的影響，總結(jié)手術(shù)技巧與經(jīng)驗(yàn)。 方法取成年上半身標(biāo)本13例，觀察經(jīng)脊柱后正中入路的解剖層次、椎管及其毗鄰結(jié)構(gòu)，測(cè)量各椎體椎板數(shù)據(jù)，掌握脊柱區(qū)的解剖特點(diǎn)，為臨床手術(shù)入路提供科學(xué)基礎(chǔ)。收集并整理2012年2月到2014年1月份經(jīng)半椎板入路切除椎管內(nèi)腫瘤患者32例及以全椎板入路切除椎管內(nèi)腫瘤患者38例的臨床資料。分析兩組患者性別、年齡、發(fā)病部位、腫瘤類型、發(fā)病時(shí)間。比較兩組手術(shù)時(shí)間、術(shù)中出血量、下床時(shí)間、住院時(shí)間、手術(shù)切除率。采用McCorick臨床分級(jí)標(biāo)準(zhǔn)，，對(duì)比患者愈后情況及術(shù)后并發(fā)癥。所有病例術(shù)后均隨訪，評(píng)價(jià)患者后期脊柱穩(wěn)定性。所有數(shù)據(jù)均采用spss統(tǒng)計(jì)分析軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果對(duì)兩組患者基本信息（性別、年齡、腫瘤部位、腫瘤類型、發(fā)病時(shí)間）應(yīng)用統(tǒng)計(jì)軟件進(jìn)行組內(nèi)統(tǒng)計(jì)學(xué)分析，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。故兩組患者基本情況差異均無(wú)統(tǒng)計(jì)學(xué)意義，具有可比較性。應(yīng)用T檢驗(yàn)比較兩組患者手術(shù)時(shí)間、住院時(shí)間、術(shù)中出血量、下床時(shí)間均有統(tǒng)計(jì)學(xué)意義（P＜0.05）。應(yīng)用卡方檢驗(yàn)比較兩組患者手術(shù)切除率，兩組患者手術(shù)切除率差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。對(duì)兩組患者愈后進(jìn)行評(píng)價(jià)，兩組患者應(yīng)用卡方檢驗(yàn)進(jìn)行比較，無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。半椎板組住院期間無(wú)并發(fā)癥發(fā)生，全椎板組住院期間出現(xiàn)并發(fā)癥4例；半椎板組經(jīng)隨訪無(wú)脊柱畸形發(fā)生，全椎板組脊柱畸形發(fā)生4例。兩組患者應(yīng)用卡方檢驗(yàn)比較，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。經(jīng)半椎板入路切除椎管內(nèi)腫瘤與經(jīng)全椎板入路切除椎和內(nèi)腫瘤比較在癥狀改善程度相同、腫瘤切除率方面無(wú)明顯差異，半椎板組手術(shù)時(shí)間、術(shù)中出血、術(shù)后下床時(shí)間、術(shù)后并發(fā)癥、遠(yuǎn)期脊柱穩(wěn)定性等方面明顯優(yōu)于全椎板組。 結(jié)論單側(cè)半椎板入路切除椎管內(nèi)腫瘤具有損傷小，術(shù)后早期下床活動(dòng)，近期及遠(yuǎn)期臨床效果顯著，有利于脊柱穩(wěn)定性的維持，雖有暴露局限的缺點(diǎn)，但在顯微鏡下先行瘤內(nèi)切除其操作空間已足夠，可以滿足大部分椎管內(nèi)腫瘤的切除。
[Abstract]:Objective to determine the anatomical level and exposure of intraspinal tumors by posterior median approach. To compare and analyze the two operative methods of resection of intraspinal tumors through the approach of semilateral laminectomy and total laminectomy, and to discuss the advantages and disadvantages, clinical indications, clinical effects and effects on the stability of the spinal column. Summarize surgical skills and experience. Methods Thirteen adult upper half body specimens were collected to observe the anatomical level, spinal canal and adjacent structure of the posterior median spinal approach, to measure the data of the vertebral lamina, to master the anatomical characteristics of the spinal area, and to provide a scientific basis for the clinical approach. From February 2012 to January 2014, the clinical data of 32 patients with intraspinal tumor and 38 with total laminectomy were collected and analyzed. The sex, age, location, tumor type and onset time of the two groups were analyzed. The time of operation, the amount of blood lost during operation, the time of getting out of bed, the time of hospitalization and the rate of resection were compared between the two groups. McCorick clinical grading standard was used to compare the recovery and postoperative complications. All cases were followed up to evaluate the spinal stability. All the data were analyzed by spss software. Results the basic information (sex, age, tumor location, tumor type, onset time) of the two groups were analyzed by statistical software. There was no significant difference between the two groups (P > 0.05). Therefore, the two groups of patients with no statistical difference in basic conditions, comparable. T test was used to compare the time of operation, hospital stay, blood loss during operation and time of getting out of bed between the two groups (P < 0.05). Chi-square test was used to compare the surgical resection rate between the two groups. There was no significant difference in the surgical resection rate between the two groups (P > 0.05). There was no significant difference between the two groups by chi-square test (P > 0.05). There were no complications in the hemivertebrae group, 4 cases in the whole laminar group, and 4 cases in the whole laminar group after follow-up. There was significant difference between the two groups by chi-square test (P < 0.05). The degree of symptom improvement was the same as that of total laminectomy and total laminectomy, but there was no significant difference in tumor removal rate. The operation time, bleeding and the time of getting out of bed after operation were not significantly different between the hemilaminectomy group and the total laminectomy group. Postoperative complications and long-term spinal stability were significantly superior to those in the whole laminar group. Conclusion unilateral semilateral laminectomy of intraspinal tumors has the advantages of less injury, early movement after operation, short term and long term clinical effects, which is beneficial to the maintenance of spinal stability, although it has the disadvantages of exposure limitation. However, the operation space of the first tumor resection under microscope is enough to satisfy the excision of most intraspinal tumors.
【學(xué)位授予單位】：河北聯(lián)合大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.42

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