保留棘突行全椎板截骨回植在胸腰椎管内原发肿瘤手术治疗中的应用

Application of total laminectomy with preserved spinous process and replantation for the primary tumor of the thoracolumbar spinal canal

目的 探讨保留棘突行全椎板截骨回植在胸腰椎管内原发肿瘤手术治疗中的临床应用价值.方法 采用回顾性队列研究方法.纳入2013年7月—2017年7月山东大学齐鲁医院(青岛)骨肿瘤科胸腰椎管内肿瘤患者92例,男48例、女44例,年龄41~79(53.9 ± 10.2)岁.均采用全椎板截骨、肿瘤切除、截骨块回植、椎弓根内固定术治疗.按是否保留棘突行椎板截骨分为保留棘突截骨组(34例)及不保留棘突截骨组(58例).记录两组患者手术时间、出血量,随访观察肿瘤复发、回植骨块融合情况,术后功能以及并发症情况,比较两组患者术后3个月胸腰部疼痛视觉模拟评分(VAS)以及日本骨科协会(JOA)神经功能评分.结果 所有患者手术顺利,彻底切除病变.保留棘突截骨组手术时间(188 ± 17) min、术中出血量(386 ± 50) mL,不保留棘突截骨组手术时间(190 ± 16) min、术中出血量(380 ± 44) mL,两组比较差异均无统计学意义(t时间 = -0.564, t出血量 =0.604, P值均>0.05).术后3个月时,保留棘突截骨组VAS为(2.07 ± 0.28)分、JOA评分为(15.6 ± 1.8)分,不保留棘突截骨组VAS为(2.45 ± 0.30)分,JOA评分为(13.8 ± 2.0)分,两组比较差异均有统计学意义(tVAS = -5.881, tJOA =4.374, P值均<0.01);保留棘突截骨组术后骨性融合时间(4.0 ± 0.6)个月与不保留棘突截骨组(4.4 ± 0.7)个月比较,差异有统计学意义(t= -2.646, P<0.01).结论 保留棘突行全椎板截骨回植技术应用于胸腰椎管内原发肿瘤的手术治疗中,有利于脊柱的后方解剖结构恢复、促进功能康复及骨融合.

Objective To investigate the clinical effect of total laminectomy with preserved spinous process and replantation for the treatment of primary tumor of the thoracolumbar spinal canal.Methods A retrospective analysis.From July 2013 to July 2017,92 patients with primary tumor of thoracolumbar spinal canal were included,with 48 male,44 female;aged 41-79 years old,average(53.9±10.2)years old.All patients treated with total laminectomy tumor resection,osteotomy replantation and pedicle internal fixation.According to whether or not to preserve spinous process,92 patients were divided into two group,preserved spinous process group(34 patients)and without preserved spinous process group(58 patients).The operative time,bleeding volume,recurrence of tumors,fusion of bone grafts,postoperative function and complications were observed.Visual analogue scale(VAS)in thoracolumbar spine and Japanese Orthopaedic Association(JOA)nerve function score were compared between the two groups.Results All patients underwent successful operation,and the lesions were completely removed.The time of operation in with preserved spinous process group was(188±17)min,which was no significantly different from that in without preserved spinous process group(190±16)min(t=-0.564,P>0.05).The amount of bleeding in with preserved spinous process group was(386±50)mL,and the difference was no statistically significant(t=0.604,P>0.05)with without preserved spinous process group(380±44)mL.After 3 months of the with preserved spinous process group VAS preoperative average score was(2.07±0.28)points,and without preserved spinous process group was(2.45±0.30)there was significant difference(t=-5.881,P<0.01).In the with preserved spinous process group,JOA average score was(15.6±1.8)points,and without preserved spinous process group was(13.8±2.0)points there was significant difference(t=4.374,P<0.01).In the with preserved spinous process group,bone fusion time was(4.0±0.6)months,and without preserved spinous process group was(4.4±0.7)months there was significant difference(t=-2.646,P<0.01).Conclusions Total laminectomy with preserved spinous process and replantation for the treatment of primary tumor of the thoracolumbar spinal canal is benefical to the restoration of the anatomical structure of the spine,functional rehabilitation and bone fusion.