超声骨刀椎板成形椎板植骨在椎管肿瘤手术中的应用

Recapping Laminoplasty Using Ultrasonic Bone Curette and Bone Graft in Lamina of Vertebra for Intraspinal Tumors

目的探讨超声骨刀切开、棘突椎板复合体回植、钛板固定、椎板植骨在椎管内肿瘤切除术中的应用价值。方法 2014年7月~2016年7月,在88例颈、胸、腰椎椎管内肿瘤(长1~11 cm,平均3.2 cm)手术中,采用超声骨刀沿关节突内侧2~3 mm切开两侧的椎板,将棘突椎板复合体完整取下,处理完椎管内肿瘤后再将棘突椎板复合体原位回植,钛板固定,完成椎管成形,并在椎板切开部位植骨融合。结果肿瘤全切除81例,次全切除7例。切除椎板数1~5个,平均2.5个。未出现因超声骨刀椎管开窗、钛板置入所致的硬脊膜破损、脊髓和脊神经根损伤等并发症。随访3~12个月,中位数3个月,未见回植组织移位、塌陷、畸形愈合及椎管狭窄,未见不稳定或畸形,可见植骨融合。结论椎管内肿瘤术中采用超声骨刀椎管后路切开钛板固定棘突椎板复合体的方法简便、安全、可靠,辅以植骨融合有利于保持脊柱的完整性及稳定性,近期效果满意。

Objective To study the value of replantation of the spinous process and lamina complex removed by ultrasonic bone curette,fixation with titanium plate and bone graft in lamina of vertebra in the resection of intraspinal tumors. Methods A total of 88 patients with cervical,thoracic or lumbar spinal cord tumors(1-11 cm in length with a mean of 3.2 cm)who received recapping laminoplasty in our hospital from July 2014 to July 2016 were retrospectively analyzed.The patients underwent en bloc laminectomy by ultrasonic bone curette along a line 2-3 mm away from the medial side of the facet.The spinous process and lamina complex were replanted in situ and fixed by titanium plate after resection of spinal cord tumors.Bone graft was performed at incision site of lamina. Results There were 81 cases of total resection and 7 cases of subtotal resection.A total of 1-5(mean,2.5)laminae were removed.No patient suffered from dura mater tear or injury to the spinal cord,or nerve root due to ultrasonic bone curette and titanium plate fixation.The patients were followed up for 3-12 months(median,3 months),during which no malunion,spinal stenosis,displacement or collapse of the replanted tissues occurred.No instability or deformity of the spine was found.Primary bone fusion was confirmed by CT. Conclusions Replantation of the spinous process and lamina complex removed by ultrasonic bone curette and fixation with titanium plate in the resection of spinal cord tumors is simple,safe,and reliable.It is conducive to the integrity and stability of the spine with bone graft fusion performed in lamina of vertebra.