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第三军医大学大坪医院野战外科研究所脊柱外科
纸质出版日期:2014,
网络出版日期:2014-03-30,
移动端阅览
王颖博, 朱军, 柳峰, 等. 椎管内肿瘤切除术中脊柱稳定性重建方式的选择:单中心5年经验[J]. 陆军军医大学学报, 2014,36(6):537-540.
WANG YINGBO, ZHU JUN, LIU FENG, et al. Strategies of spine reconstruction for intraspinal tumor removal: a single-center, retrospective analysis of 5 years’ experience. [J]. Journal of army medical university, 2014, 36(6): 537-540.
王颖博, 朱军, 柳峰, 等. 椎管内肿瘤切除术中脊柱稳定性重建方式的选择:单中心5年经验[J]. 陆军军医大学学报, 2014,36(6):537-540. DOI:
WANG YINGBO, ZHU JUN, LIU FENG, et al. Strategies of spine reconstruction for intraspinal tumor removal: a single-center, retrospective analysis of 5 years’ experience. [J]. Journal of army medical university, 2014, 36(6): 537-540. DOI:
目的 探讨椎管内肿瘤手术治疗中脊柱稳定性重建方式的选择并评价其疗效。 方法 回顾性分析2008年1月至2012年6月于我科实施椎管内肿瘤切除、重建脊柱稳定性手术的73例患者资料,包括男性39例,女性34例,年龄16~68岁
平均32.7岁。肿瘤完全位于硬膜内38例,其余椎管内肿瘤35例。对完全位于硬膜内的肿瘤,采用棘突椎板韧带复合体回植、微型钛板固定术,其余肿瘤采用椎板部分或全切、椎弓根螺钉内固定、植骨融合术。 结果 手术时间180~270 min,平均210 min。失血量300~1 200 mL,平均660 mL。术后随访6~39个月,除1例C
2
~C
3
髓内脂肪瘤出现暂时性脊髓功能障碍加重外,其余病例术后未出现医源性脊髓损伤,未出现内固定物松动、切口感染,未见回植组织移位、塌陷及继发椎管狭窄。术后动力位X线片比较棘突椎板回植术后脊柱活动度基本得以保留,椎弓根螺钉内固定术后固定节段脊柱可获牢固融合。 结论 肿瘤完全位于硬脊膜内者,可经后路整体切除椎板,钛板固定棘突椎板复合体;对于椎间关节稳定性结构已破坏者,给予后路椎弓根螺钉内固定及植骨融合术。
Objective To explore the surgical treatment strategies and the evaluation of the therapeutic efficacy for spine reconstruction after intraspinal tumor removal. Methods We retrospectively analyzed a series of 73 patients with intraspinal tumor who were treated surgically from January 2008 to June 2012. There were 39 males and 34 females with the average age of 32.7 years ranging from 16 to 68. Completely intradural tumors existed in 38 patients
and tumors in vertebral ca
nal in 35 patients. The patients with completely intradural tumors underwent en bloc laminectomy. The spinous process and lamina complex was replanted
in situ
and fixed by titanium plate after resection of spinal cord tumors.Other patients treated with pedicle screw internal fixation surgery. Results The operation time varied from 180 to 270 min
with an average of 210 min. The blood loss varied from 300 to 1 200 mL
with median volume of 660 mL. One patient who suffered from lipomyoma located at C
2
-C
3
showed spinal dysfunction. All patients were followed up for 6 to 39 months
during which no malunion
infection
spinal stenosis
displacement or collapse of the replanted tissues
or looseness or shift of internal fixation was observed.By comparing Flexion-extension radiographs
replantation of the spinous process and lamina complex and fixation with titanium plate in the resection of intraspinal tumors kept spinal mobility well. Pedicle screw fixation resulted in an ideal stability. Conclusion Surgical approach of resection of intraspinal tumor should be selected according to the location and whether the tumor causes destruction of the intervertebral joint stability. The completely intradural tumors should be treated by en bloc laminectomy
with spinous process and lamina complex replanted in situ and fixed by titanium plate after resection of intraspinal tumor. When the intervertebral joint stability is destroyed by tumors
the patients should be treated by pedicle screw fixation to restore the stability.
椎管内肿瘤椎板切除术内固定术
intraspinal tumorlaminectomyinternal fixation
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