椎板切开复位术在成人椎管内肿瘤术中的应用

The application of laminoplasty in the spinal cord tumors operation of adults

目的评价椎板切开复位术在成人椎管内肿瘤切除术中的应用价值及术后椎管的稳定性变化。方法经后正中人路行椎管内肿瘤切除72例，术中分开椎旁肌，取下相应病变节段椎板、棘突。在显微镜下切除椎管内肿瘤后，将取下的椎板用钛片-钛钉固定复位，将椎旁肌解剖复位。分析此术式对椎管内肿瘤的显露与切除效果，评价术后患者的神经功能。结果72例病人中髓内室管膜瘤18例，血管网织细胞瘤6例，髓外硬膜下神经鞘瘤22例，脊膜瘤21例，先天性肿瘤5例。椎板切开复位节段2—6节段（平均3．8节段），肿瘤全切68例，全切率94．4％。共27例病人获得随访，随访率37．5％，术后随访时间6个月到2．5年（平均11个月）。所有随访病例均在术后7d到2．5年间检查MRI、X线片。结论椎板切开对椎管内肿瘤的暴露及切除效果满意，可减少椎板切除术后脊柱畸形的发生，对脊柱的稳定性影响较小。

Objective Laminoplasty has become a popular technique for the treatment of spinal cord tumors. The goal of this technique is to evaluate the effectiveness and biomechanical stability of Double- door and reconstructing of the laminae and relevant posterior elements used for adult spinal cord tumors resection. Method A series of 72 cases with spinal cord tumors removed through posterior approach from January 2006 to January 2008. During the operation, departing the para-vertebral muscle above the dorsal spine with preserving supraspinal ligament and interspinal ligaments, the laminae and relevant posterior elements were removed. After the tumor resection under microscope, the structure was replaced back to its previous levels and fixed with titanium miniplates. Drilling on spinous process, the para-vertebral muscle was suturing to its previous position. The surgical outcome of the procedure was analyzed, along with the neurological function after the operation. Long-term follow-up was performed to evaluate the spine stability. Results There were intramedullary ependenoma in 18 patients; intramedullary angioreticuloma in 6 patients; intradural-extramedullary Schwannoma neurilemmoma in 22 patients; intradural-extramedullary meningioma in 21 patients ; congenital tumor （ epidermoid cyst, dermoid cyst, teratoma, enterogenous cyst, liparomphalus） in 5 patients. A mean of 3.8 laminae levels （ range from 2 - 6 levels） was exposed and reconstructed. 94.4% of the tumors were totally removed. The follow-up rate was 37. 5%;the follow-up period ranges from 6 months to 2. 5 years（ average 11 months）. All the follow-up patients received MRI and X-ray examination during 7 days to 2. 5 years after operation. There was kyphotic deformity in 1 patient in 2 years after operation. Conclusions Double-door and reconstructing of the laminae and relevant posterior elements, this modified technique provides a satisfactory operational field and has a low complication rate.