椎管内原发性肿瘤手术椎板棘突复位和切除的随机对照研究

Random Control Study of Lamina Reduction and Laminectomy in 72 Patients with Primary Intraspinal Tumor

目的评价在椎管内原发性肿瘤手术中采用椎板棘突复位和传统椎板切除的临床疗效。方法将72例椎管内原发肿瘤随机分为治疗组和对照组。治疗组行椎板棘突复位术;对照组行椎板棘突咬除术。比较两组脊髓神经功能恢复程度、脊髓截面积、脊柱不稳和成角畸形发生率。结果术后3、6、12个月脊髓损伤ASIA分级及脊髓横截面积两组比较有显著差异(P<0.01)。术后3、6、12个月治疗组未发现明显脊柱成角畸形和脊柱不稳病例;而对照组脊柱成角畸形率分别为14.71%、29.42%、58.84%,脊柱不稳率分别为23.53%、52.94%、88.24%,两组相比有显著差异(P<0.01)。结论椎板棘突复位术恢复了椎管正常生理解剖和次序,保证了脊柱的稳定,脊髓神经功能恢复完全,有效地防止了术后并发症的发生。

Objective To evaluate the curative effects of the lamina reduction and the traditionary laminectomy on the intraspinal primary tumor. Methods A total of 72 patients with intraspinal primary tumors were randomly divided into treatment group （n=38） undergoing laminectomy and anatomic implant in situ （lamina reduction） for the intraspinal tumor, and control group （n=34） only receiving laminectomy. The extent of the spinal function recovery the spinal cord transection areas of spinal stenosis spot and the incidence rates of unstable spine and angnlation anomaly were compared between both the groups. Results There were significant differences in ASIA grades and the spinal cord transection areas （P〈0.01） 3, 6 and 12 months after the treatment between both the groups. The unstable spine and angulation anomaly did not occur in the treatment group. In the control group, 3, 6 and 12 months after treatment the rates of angulation anomaly were 14.71%, 29.42% and 58.84% respectively, and the rates of the unstable spine were 23.53%, 52.94% and 88.24% respectively. There were significant differences in the rates of the unstable spine and angulation anomaly between two groups （P〈0.01）. Conclusion The lamina reduction can resume the normal anatomy and order of the vertebral structure, ensure spinal stabilization, promote the recovery of the spinal function and prevent the spinal stenosis and scar from pressing spinal cord after the operation.