摘要
目的 探讨椎管重建在不同脊髓节段椎管内肿瘤显微切除术中的应用价值。方法 武警广东总队医院神经外科自2008年12月至2013年6月共行显微切除术治疗103例椎管内肿瘤患者，术中均行椎管重建：根据肿瘤的部位、大小，采用微型磨钻或微型摆锯切开一个或多个椎板，保留其棘上、棘间韧带，将椎板棘突整体取下，肿瘤切除后再原位回植，用钛连接片固定并重建椎管，其中行全椎板入路椎管重建64例，行半椎板入路椎管重建31例，行椎板间开窗椎管重建8例；行一个节段椎管重建者12例，行2～3个节段椎管重建者57例．行4～5个节段椎管重建者32例，行6个节段椎管重建者2例。术后行椎管MRI／CT三维成像，观察椎管重建情况。结果 本组肿瘤全切除97例（94．2％），次全切除6例（5．8％）。所有患者均未出现因磨钻或微型摆锯行椎管开窗、钛片植入所致的硬脊膜破损、脊髓或脊神经根损伤等并发症。术后按Frankel标准评定疗效为优良88例，显效12例，差3例。随访1-6年，MRI／CT三维重建复查均未见椎管狭窄及滑脱，无神经根性疼痛等并发症，肿瘤复发6例。结论 根据肿瘤不同性质、部位及与脊髓相对位置，采用显微手术切除肿瘤并行椎管重建，既能保证肿瘤较完整切除，又能维护脊柱的完整性及稳定性。
Objective To investigate the value of reconstruction of spinal canal in microsurgical excision of intraspinal tumors at different segmental spine. Methods One hundred and three patients with intraspinal tumors, admitted to our hospital from December 2008 to June 2013 and performed microsurgical excision, were chosen in our study; reconstruction of spinal canal was performed in the surgery： according to the position and size of the tumors, one or more vertebral lamina were excisioned by micro drill or swing saw; after the tumors were resected, the excised vertebral lamina were retighted by micro titanium plate. The canal was reconstructed via laminectomy approach in 64 patients, via hemilaminectomy approach in 31, and via part laminectomy approach in 8. One segment of spinal canal reconstruction was performed in 12 patients, 2-3 segments in 57, 4-5 segments in 32 and 6 segments in 2. All patients were followed up and spinal reconstruction by MRI and CT was performed. Results Total tumor resection was achieved in 97 patients （94.2%） and subtotal resection in 6 （5.8%）. The dura, spinal cord and nerve root were not damaged by micro drill or swing saw. The theraputic effect was evaluated accoding to Frankel criteria postoperatively： good recovery was achieved in 88 patients, effective treatment in 12 and bad recovery in 3. Follow up for 1 to 6 years was achieved. No spinal stenosis or slippage was noted by imaging reexamination, and tumors recurred in 6 patients. Conclusion Accoding to the nature of tumor, segments of the spinal cord and tumor positions relative to the spinal cord, individualized treatment protocols should be adopted, and reconstruction of spinal canal can maintain spinal stabilization.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2014年第10期1022-1025,共4页
Chinese Journal of Neuromedicine
关键词
椎管内肿瘤
椎管重建
显微外科手术
Intraspinal tumor
Spinal canal reconstruction
Microsurgery
