摘要
目的：观察椎板-棘突复位椎管重建术在椎管内肿瘤后正中入路手术治疗中临床应用的效果和可行性。方法对2011年7月至2013年12月赤峰学院附属医院收治15例椎管内肿瘤患者（神经鞘瘤11例，脊膜瘤及室管膜瘤均1例，胆脂瘤2例），均采取后正中入路肿瘤切除术，术中保留椎板-棘突，肿瘤切除后将其成形复位并以钛片钛钉固定，局部自体骨回植。其他手术操作同椎板切除术。术前后行CT、MRI及病理学检查。术后随访，观察切口愈合、脊柱完整性、稳定性、活动度，测量术区椎管腔矢状径并做统计学分析。结果15例肿瘤全部切除，术前症状明显改善或消失，切口7～9d拆线，Ⅰ/甲愈合，无脑脊液漏发生。无排异反应。随访3个月～2年，患者均无牵张、挛缩、异物感等主观不适反应，脊柱容量与外形饱满、无塌陷及移位，无椎管狭窄，椎板-棘突获得骨性愈合，复查CT及MRI检查结果满意。结论椎板-棘突复位椎管重建术方法简单实用，有效保护了脊柱的完整性、稳定性和活动度，未继发椎管狭窄，适用于椎管内肿瘤切除后的治疗。
Objective To explore the therapeutic effects of Spinal canal reconstruction with autologous spinous process-lamina complex replanted and fixed by titanium sheet and pins after resection of intraspinal tumors .Methods Among 15 patients with intraspinal tumors at our hospital from July 2011 to December 2013, there were schwannoma （n=11）, spinal meningioma （n=1）, ependymoma （n=1） and epidermoid cyst （n=2）.All resections were performed via a posterior midline approach .And the clinical data were analyzed .The spinous process and lamina complex were resected en bloc by burr drill and reserved with interior sclerotin bitted .Then replantation in situ and fixation by titanium sheet and pins were performed after a resection of intraspinal tumors and skeletal fragment was replanted into bone gaps .Laminoplasty were finished and other procedures were the same as laminectomy . Computed tomography 3-demsional reconstruction, magnetic resonance imaging （MRI） and pathological examination were performed before and after operations .Wound healing , spinal integrity , stability and activity were evaluated .Sagittal diameters of spinal canal lumina in operative area were measured and analyzed statistically .Results Fifteen tumors in 15 patients were totally resected while preoperative symptoms improved significantly or disappeared .Incision stitches were removed at days 7-9 post-operation with excellent healing .There was neither cerebrospinal fluid leakage nor local or systemic rejection .During a follow-up period of 3 to 24 months, there was an onset of such subjective discomforts as distraction , contracture and foreign body sensation .No spinal stenosis , collapse or displacement of replanted tissues occurred .Spinal capacities and shapes were plump .There was no collapse and displacement along healed lamina bony .CT and MRI results were satisfactory .No significant difference was found between peri-and post-operative sagittal diameters of spinal canal lumina （P＆gt;0.05）. Conclusion After resection of intraspinal tumors , spinal canal reconstruction with autologous spinous process-lamina complex reduction is both simple , practical and effective for protecting spinal integrity , stability and activity .
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第25期1960-1962,共3页
National Medical Journal of China
关键词
椎板切除术
修复外科手术
脊髓肿瘤
椎管狭窄
Laminectomy
Reconstructive Surgical Procedures
Spinal cord neoplasms
Spinal stenosis
