不同节段椎板切除对腰椎椎管内肿瘤术后脊柱稳定性的影响

Different segments laminectomy on lumbar spinal tumor surgery spinal stability

背景：腰椎椎管内肿瘤通常采用腰椎全椎板切除手术，此类手术具有较大减压范围，切除病灶彻底，术野较好，但术后腰椎稳定性不佳，尤其是多节段椎板切除患者。目的：探讨腰椎椎管内肿瘤患者不同节段椎板切除对术后脊柱稳定性的影响。方法：选取2012年10月至2015年6月重庆市中医院收治的腰椎椎管内肿瘤患者120例，所有患者均给予全椎板切除术，对治疗效果情况进行分析，观察不同节段椎板切除对术后脊柱稳定性的影响。结果与结论：①44例疼痛患者在术后疼痛状况显著缓解，36例感觉障碍患者症状缓解，11例运动障碍患者肌力恢复正常，5例尿便障碍者症状显著改善；②术后ASIA分级评估：Ⅰ级3例，Ⅱ级5例，Ⅲ级12例，Ⅳ42例，Ⅴ级58例；③1个节段的全椎板切除术后脊柱失稳率显著低于多个节段的椎板切除，差异有显著性意义（P〈0．05）；④结果提示，对于腰椎椎管内肿瘤患者采用单节段全椎板切除的术后腰椎稳定性更高，2个或以上节段的椎管内肿瘤患者需根据肿瘤的具体情况选择相应修复方式，尽可能降低术后腰椎失稳率。

Objective：To explore the different segments within the applied laminectomy lumbar spinal surgery on tumor patients after spinal stability. Methods： 120 cases of lumbar spinal cancer patients in October 2012 to June 2015 were treated, and all patients received total laminectomy, therapeutic effects were analyzed. Results：44 cases of postoperative pain in patients with painful conditions significantly alleviated,disorder 36 cases the patient feels symptoms, 11 cases of normal muscle movement disorders,five cases significantly improved symptoms of bowel and bladder disorders;ASIA grading and assessment：grade I 3 Li grade I[ 5ceses,grade m12cases,N42 cases, v grade 58 cases;laminectomy a segmental resection of spinal instability was significantly lower than the laminectomy plurality of segments,the difference was significant （P 〈 0.05）. Conclusion：For patients with lumbar spinal tumors higher single segment laminectomy surgery postoperative lumbar stability, two or more spinal segments cancer patients need to select the appropriate surgical approach based on tumor specific circumstances,to minimize the rate of postoperative lumbar instability.