摘要
目的探讨改良椎管扩大成形术在椎管内肿瘤手术中的应用价值及适应证。方法回顾性分析38例应用改良椎管扩大成形术治疗的椎管内肿瘤临床资料。手术中对椎板截骨架起回植固定椎管扩大成形术进行改良。分析此术式对肿瘤的显露和切除情况,随访患者的临床疗效、脊柱稳定性及并发症,探讨手术适应症。结果根据肿瘤位置,手术行椎管扩大成形2～6节段,平均3.5节段。椎管内外哑铃型肿瘤6例,硬膜下肿瘤22例,髓内肿瘤10例。肿瘤全切除28例,次全切除10例。术后随访6个月至2年,JOA评分从术前(8.6±2.7)分提高到末次随访(14.1±2.6)分,平均改善率为82.5%±9.4%,优良率达76.3%。所有患者成型椎板复位固定情况良好,骨性融合情况良好。成形节段椎管腔矢状径较术前增加1～4 mm,平均3.2 mm。无并发症出现,未见脊柱不稳定病例。结论改良椎管扩大成形术对椎管内肿瘤显露和手术效果良好,对脊柱的稳定性影响小,能减少手术并发症。主要适用于椎管内大型较长节段肿瘤、恶性肿瘤及预计不能全切除的肿瘤,尤其适用于儿童。
Objective To investigate the surgical application and indications of the modified expanding suspended laminoplasty for spinal tumors.Methods Clinical data of 38 cases of spinal tumors performed the modified laminoplasty were analyzed retrospectively.A modified surgical technique of lamina replantation and fixation were applied during the operation.The exposure and resection of tumors were analyzed.Clinical outcomes,spinal stability and complications were followed up and the indications of the surgical technique were discussed.Results According to the location of tumors,the segments of vertebral column involved in the operation varied from two to six（mean 3.5 segments）.Six cases of dumbbell-shaped intra-and extra-spinal tumors,22 cases of spinal subdural tumors,and 10 cases of intramedullary tumors were included in the study.Total resection was achieved in 28 cases and subtotal resection in 10 cases.During 6 months^2 years＇ follow-up,JOA score was increased from 8.6±2.7 preoperation to 14.1±2.6 postoperation,with an improvement rate of 82.5%±9.4% and an excellent rate of 76.3%.The lamina replantation,fixation and bone-graft fusion were satisfactory in all the cases.The sagittal diameter of spinal canal was increased by 1~4 mm（mean 3.2 mm） postoperatively.There was no complications and spinal instability.Conclusion Modified expanding suspended laminoplasty is effective for tumor exposure and resection,with less influence on the spinal stability,less complications and better clinical outcomes.It is applicable to giant and multiple segment-involved spinal tumors,malignant tumors and those that can not be totally resected,with pediatric patients in particular.
出处
《中华神经外科疾病研究杂志》
CAS
2011年第3期248-251,共4页
Chinese Journal of Neurosurgical Disease Research
