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

Replantation of lamina and spinous process using hollow screw in the surgery on thoracolumbar intraspinal tumors

中文关键词:  椎管内肿瘤  棘突椎板复合体  空心螺钉  椎管成形术

英文关键词:Spinal cord neoplasms  Pinous process and vertebral plate complex  Cannulated screws  Laminoplasty

中文摘要:

  【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（P＜0.05），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。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of replantation of spinous process and vertebral plate complex by using cannulated screws for the primary intraspinal canal tumors． Methods: From February 2011 to October 2015, spinous process and vertebral plate complex replantation by using cannulated screws was performed in 31 patients after intraspinal tumor removal. 26 patients received follow-up(11 males and 15 females). Onset ages ranged from 29 to 76 years old(average, 46.5±8.4 years)． After surgery, CT and X-ray were used to assess the spinal stability and vertebral canal formation. MRl was adopted to evaluate the tumor recurrence. The Japanese Orthopaedic Association(JOA) was used to evaluate the curative effects. Results: During operation, all 64 cannulated screws were smoothly placed. The mean operation time was 75-148 min(96±21 min) and the mean bleeding volume was 170-305ml(225±32ml). Among these patients, 4 cases had a cerebrospinal fluid leakage, without spinal cord injury or infection. 26 patients were followed up for an average of 13.5±2.1 months(range, 6-28 months). X-ray showed no vertebral instability or spondylolisthesis. Although the facet joint was involved at two levels as shown by CT, no screw breakage or displacement was observed, and the fusion rate accounted for 76.9%. MRI showed no recurrence. The symptoms improved significantly after operation, the JOA score was 11.2±2.1 before surgery and 24.6±2.8 at final follow-up, significant difference existed between postoperation and preoperation(P＜0.05), with the excellent rate of 80.8%. Conclusions: The replantation of spinous process and vertebral plate complex by using cannulated screws after the resection of intraspinal canal tumors may reconstruct the vertebral canal and maintain the spinal stability, which is an effective procedure in avoiding iatrogenic spinal stenosis.