椎板成形术与椎板切除联合钉棒内固定术在椎管内肿瘤切除中的临床疗效分析

Clinical Efficacy Analysis on Laminoplasty Surgery and Laminectomy with Screw-Rod Internal Fixation for Resection of Intraspinal Tumor

目的分析椎板成形术与椎板切除联合钉棒内固定术在椎管内肿瘤切除中的临床疗效。方法回顾性分析2014年10月至2018年6月南京医科大学附属淮安第一医院脊柱外科及神经外科共收治的64例椎管内肿瘤患者的临床资料,按照手术方式不同分为对照组(n=28)和观察组(n=36)。对照组采用椎板切除联合钉棒内固定术治疗,观察组采用椎板成形术治疗。治疗后,对两组患者的症状改善、抗生素使用天数、住院费用、术中输血率、术中出血量、手术时间及术后卧床时间、并发症发生情况进行比较。结果观察组的疗效优于对照组(P<0.05)。观察组抗生素使用天数、住院费用、术中出血量明显少于对照组[1.0(1.0,6.0)d比7.0(5.0,11.8)d,(38251±1479)元比(52514±2553)元,(175±41)mL比(466±201)mL];观察组术中输血率明显低于对照组[0(0)比75.0%(21/28)];观察组的术后卧床时间明显长于对照组[14.0(13.0,15.0)d比3.0(3.0,4.0)d](P<0.05)。观察组发生单纯脑脊液漏4例,脑脊液漏合并感染1例;对照组发生单纯脑脊液漏2例,脑脊液漏合并感染4例,两组患者的并发症发生率比较差异无统计学意义(P>0.05)。结论椎板成形术较椎板切除联合钉棒内固定术在切除椎管内肿瘤上具有明显优势,对椎管内肿瘤切除手术方式的选择具有借鉴作用。

Objective To analyze the clinical effect of laminoplasty vs laminectomy combined with screw-rod internal fixation in the resection of intraspinal tumors.Methods The clinical data of 64 cases of intraspinal tumor in Department of Spinal Surgery and Neurosurgery of the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University From Oct.2014 to Jun.2018 were retrospectively analyzed,and the patients were divided into a control group(n=28)and an observation group(n=36)according to different operation methods.The control group was treated with laminectomy and screw-rod internal fixation;the observation group was treated with laminoplasty.The symptom improvement,days of antibiotic use,hospitalization expenses,intraoperative blood transfusion rate,intraoperative bleeding volume,operation time,bed time and complications of the two groups were compared.Results The efficacy of the observation group was better than that of the control group(P<0.05).The observation group was significantly less than the control group in the days of antibiotic use,hospitalization costs and intraoperative bleeding[1.0(1.0,6.0)d vs 7.0(5.0,11.8)d,(38251±1479)yuan vs(52514±2553)yuan,(175±41)mL vs(466±201)mL];the intraoperative blood transfusion rate of the observation group was significantly lower than that of the control group[0(0)vs 75.0%(21/28)];the time of bed rest in the observation group was significantly longer than that in the control group[14.0(13.0,15.0)d vs 3.0(3.0,4.0)d](P<0.05).In the observation group,there were 4 cases of cerebrospinal fluid leakage and 1 case of cerebrospinal fluid leakage with infection;in the control group,there were 2 cases of cerebrospinal fluid leakage and 4 cases of cerebrospinal fluid leakage with infection.There was no significant difference in the incidence of complications between the two groups(P<0.05).Conclusion The laminoplasty for intraspinal tumors is superior to the laminectomy with screw-rod internal fixation for intraspinal tumors.It is useful to choose which approach is better to resect spinal cord tumor.