半椎板入路切除与全椎板入路切除合并脊柱内固定治疗椎管内原发肿瘤的研究

Unilateral Hemilaminectomy and Laminectomy Combined with Spinal Instrumentation in the Treatment of Intraspinal Primary Tumors

目的对半椎板入路切除与全椎板入路切除合并脊柱内固定治疗椎管内原发肿瘤的临床效果进行分析比较。方法选取82例椎管内原发肿瘤患者,按照手术方式不同将其分为观察组43例及对照组39例。观察组患者行半椎板入路切除,无需合并脊柱内固定,对照组患者行全椎板入路切除合并脊柱内固定治疗。对两组患者的肿瘤切除情况、围手术期指标以及近远期疗效进行观察与对比。结果观察组肿瘤全切除率为93.02%,对照组为92.31%,两组相比差异无统计学意义(P>0.05);观察组患者围手术期指标各方面均显著优于对照组,差异有统计学意义(P<0.05);观察组患者手术后近远期疗效均得到明显改善,其中以大小便障碍恢复较差,其他如神经根性疼痛、感觉及运动障碍则恢复较好;观察组患者治疗总有效率为97.67%,显著高于对照组(84.62%),差异有统计学意义(P<0.05)。此外,观察组患者脊柱不稳定发生率(0)显著低于对照组(10.26%),差异有统计学意义(P<0.05)。结论与全椎板入路切除相比,半椎板入路切除具有创伤小、疗效好、利于脊柱稳定性的维持等优点,对于临床有手术指征的患者可考虑采用该术式进行治疗。

Objective To compare the clinical efficacy of unilateral hemilaminectomy and laminectomy combined with spinal instrumentation in the treatment of intraspinal primary tumors.Methods 82 patients with intraspinal primary tumors were divided into the observation group with 43 cases and the control group with 39 cases according to different surgical methods.The observation group underwent unilateral hemilaminectomy,and the control group underwent laminectomy combined with spinal instrumentation.Tumor resection rate,perioperative indicators and short-term and long-term efficacy of the 2 groups were observed and compared.Results Tumor resection rate of the observation group was 93.02%,there had no statistically difference compared with the control group（ 92.31%）.Perioperative indicators of the observation group were obviously higher than the control group with statistically significance（ P 0.05）.The short-term and long-term efficacy of the observation group increased,but the improvement defecation function disturbance was worse than radicular pain and sensory andmotor deficits.The total efficacy of the observation group was 97.67%,which was obviously higher than the control group（ 84.62%） with statistically significance（ P 0.05）.The spinal instability rate of the observation group（ 0） was obviously lower than the control group（ 10.26%） with statistically significance（ P 0.05）.Conclusion Unilateral hemilaminectomy has less trauma and better efficacy with stability of spinal,which can be used in treatment of intraspinal primary tumors when patients have surgery indications.