棘突椎板复合体回植联合空心螺钉固定在胸腰椎椎管内肿瘤切除术中的应用

发布时间：2018-08-19 17:13

【摘要】：目的 :探讨椎管内肿瘤切除术中应用棘突椎板复合体回植+空心钉重建脊柱后柱结构的临床疗效。方法:2011年2月~2015年10月,对31例原发性椎管内肿瘤患者行肿瘤切除术,并应用棘突椎板复合体回植联合空心钉置入重建脊柱后柱结构。其中26例患者获得随访,男11例,女15例,年龄29~76岁(46.5±8.4岁)。所有随访的患者均行X线、CT检查观察脊柱稳定性及椎管成形情况,MRI检查评价肿瘤的切除情况,术后采用日本骨科学会(Japanese orthopaedic association,JOA)评定法进行效果评定。结果:成功置入64枚空心螺钉,手术时间为75~148min(96±21min),术中出血量为170~305ml(225±32ml),4例出现脑脊液漏,未出现脊髓损伤、感染等相关并发症。随访6~28个月(13.5±2.1个月),术后动力位X线片提示脊柱活动度基本得以保留,无椎体失稳或滑脱;末次随访CT评估发现2个节段的空心螺钉累及关节突关节,没有观察到螺钉断裂或位移现象,20例(76.9%)患者达到骨性愈合;MRI示肿瘤无复发;腰椎JOA评分从术前11.2±2.1分升至末次随访时的24.6±2.8分,差异有统计学意义(P0.05),优良率达80.8%。结论:原发性椎管内肿瘤切除术中应用空心钉固定棘突椎板复合体可以有效重建脊柱后柱结构,固定可靠,能有效避免术后医源性椎管狭窄,是治疗椎管内肿瘤的有效术式。
[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 卤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 卤21min), and the intraoperative bleeding volume was 170~305ml (225 卤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 卤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 卤2.1 before operation to 24.6 卤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.
【作者单位】：福建医科大学附属南平第一医院脊柱外科;
【基金】：福建省南平市科技项目基金项目(编号:N2015Y03)
【分类号】：R739.42

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