带蒂椎板复合体回植钛网固定在椎管内肿瘤治疗中的应用

Application of laminoplasty of pedicled complex replantation on reconstruction of spinal canal at excision of intraspinal tumor

目的探讨带蒂椎板复合体回植、钛网固定,在椎管内肿瘤切除术中椎管重建的应用价值。方法对13例椎管内肿瘤患者保留双侧关节突关节,根据椎管内肿瘤的大小,采用磨钻或微型咬骨钳沿双侧关节突内侧缘打开一个或多个椎板,切断一端棘上和棘间韧带,将椎板复合体翻转,椎管内肿瘤切除后再将其原位回植,钛网固定,重建椎管完整性和脊柱的稳定性。结果 13例椎管内肿瘤全部成功切除,切除椎板数2～4个,平均(2.5±0.5)个。1例因粘连致硬脊膜破损,1例哑铃型神经鞘瘤术后6个月复发。随访12～27个月,平均(13±0.5)个月,所有病例回植物稳定,无塌陷及椎管狭窄,术后肢体瘫痪Frankel分级均有不同程度提高。结论椎管内肿瘤术中将带蒂椎板复合体翻转,术后用钛网回植固定,方法简便、安全,有利于保持椎管的完整性及脊柱的稳定性。

Objective To study the value of laminoplasty of pedicled complex replantation on reconstruction of spi- nal canal at excision of intraspinal tumor. Methods 13 patients with intraspinal canal tumors were treated in our hospi- tal. Each case was reserved bilateral facet joint, one or several vertebral lamina were cut by burr drill or micro rongeur along the inner edge of bilateral facet joint, Superspinal and interspinal ligaments of one side were cut, then pedicelar vertebral lamina complex was retroflexed and intraspinal canal was exposured. After resection of the tumor, pedicelar verte- bral lamina complex was replanted and titanic mesh was fixated to reconstruct the integrity of vertebral canal and the sta- bility of spinal column. Results The tumors of 13 cases were totally resected, 2-4（2.5±0.5 on average） lamina were re- moved. 1 case of dura mater was injured for the adhesion, 1 case Dumbbell Schwannoma was recurred after 6 months. The patients were followed up for 12 to 27 months（13±0.5 months on average） ,during which no collapse of the replan- ted tissues or spinal canal stenosis occurred. The Frankel grade was improved in different level. Conclusion Retroflexing pedicelar vertebral plate complex and fixating with titanium plate in the resection of intraspinal canal tumors is simple, safe,and is beneficial to reserve to the integrity of vertebral canal and the stability of spinal column.