半椎板入路与全椎板入路显微手术切除椎管内肿瘤的临床对比研究

发布时间：2019-01-04 06:58

【摘要】：目的通过对脊柱区的解剖明确椎管内肿瘤经后正中入路切除的解剖层次及暴露范围。对比分析经半椎板入路与全椎板入路切除椎管内肿瘤两种手术方法，探讨经半椎板切除椎管内肿瘤的优缺点、临床适应症、临床疗效以及对脊柱稳定性的影响，总结手术技巧与经验。方法取成年上半身标本13例，观察经脊柱后正中入路的解剖层次、椎管及其毗邻结构，测量各椎体椎板数据，掌握脊柱区的解剖特点，为临床手术入路提供科学基础。收集并整理2012年2月到2014年1月份经半椎板入路切除椎管内肿瘤患者32例及以全椎板入路切除椎管内肿瘤患者38例的临床资料。分析两组患者性别、年龄、发病部位、肿瘤类型、发病时间。比较两组手术时间、术中出血量、下床时间、住院时间、手术切除率。采用McCorick临床分级标准，，对比患者愈后情况及术后并发症。所有病例术后均随访，评价患者后期脊柱稳定性。所有数据均采用spss统计分析软件进行统计分析。结果对两组患者基本信息（性别、年龄、肿瘤部位、肿瘤类型、发病时间）应用统计软件进行组内统计学分析，差异无统计学意义（P＞0.05）。故两组患者基本情况差异均无统计学意义，具有可比较性。应用T检验比较两组患者手术时间、住院时间、术中出血量、下床时间均有统计学意义（P＜0.05）。应用卡方检验比较两组患者手术切除率，两组患者手术切除率差异无统计学意义（P＞0.05）。对两组患者愈后进行评价，两组患者应用卡方检验进行比较，无统计学意义（P＞0.05）。半椎板组住院期间无并发症发生，全椎板组住院期间出现并发症4例；半椎板组经随访无脊柱畸形发生，全椎板组脊柱畸形发生4例。两组患者应用卡方检验比较，差异有统计学意义（P＜0.05）。经半椎板入路切除椎管内肿瘤与经全椎板入路切除椎和内肿瘤比较在症状改善程度相同、肿瘤切除率方面无明显差异，半椎板组手术时间、术中出血、术后下床时间、术后并发症、远期脊柱稳定性等方面明显优于全椎板组。结论单侧半椎板入路切除椎管内肿瘤具有损伤小，术后早期下床活动，近期及远期临床效果显著，有利于脊柱稳定性的维持，虽有暴露局限的缺点，但在显微镜下先行瘤内切除其操作空间已足够，可以满足大部分椎管内肿瘤的切除。
[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.
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.42

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