带肌蒂单开门椎板成形术与传统椎板回植内固定术治疗腰椎髓外硬膜下肿瘤的疗效对比

Comparison of the outcomes between muscle-pedicle open-door laminoplasty and the traditional approach of lamina replantation with internal fixation in the treatment of lumbar subdural extramedullary tumor

目的:对比分析带肌蒂单开门椎板成形术与传统椎板回植内固定术两种椎板回植技术治疗腰椎髓外硬膜下肿瘤的临床疗效。方法:回顾性分析2016年3月~2018年12月青岛大学附属医院市南院区脊柱外科收治的15例腰椎髓外硬膜下肿瘤患者临床资料,根据手术方式分为两组:A组7例采用传统椎板回植内固定术治疗,B组8例采用带肌蒂单开门椎板成形术治疗。两组间性别、年龄、肿瘤类型等一般资料差异均无统计学意义(P>0.05)。记录两组病例的手术时间、术中出血量、再植或塑形椎板数量、住院时间、住院总花费、术后并发症及肿瘤复发情况,记录术前及术后7d、术后6个月疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),比较两组患者的临床效果。通过术后7d、3个月、6个月的CT检查评估椎板的骨吸收、骨融合情况。结果:两种方式均可对肿瘤进行良好的暴露和完整切除。A组患者随访时间为8.1±2.9个月,B组为8.6±3.0个月。随访期间肿瘤均未复发。两组患者在术中出血量、再植或塑形椎板数量、住院时间方面差异均无统计学意义(P>0.05)。B组患者的手术时间、住院总花费均小于A组患者(P<0.05)。两组患者术后7d、6个月的腰腿痛VAS及ODI较术前有明显下降(P<0.05),组间比较无明显差异(P>0.05)。B组1例患者术后趾感觉过敏,1周后消失;A组1例出现脑脊液漏,对症处理后痊愈。术后6个月时,A组7例患者回植椎板均未完全骨融合,B组8例患者肌蒂侧椎板均完全骨融合;A组7例观察到骨吸收,B组8例未发现骨吸收。结论:带肌蒂单开门椎板成形术与传统椎板回植内固定术治疗腰椎髓外硬膜下肿瘤均可取得良好的临床疗效;带肌蒂单开门椎板成形术手术时间缩短,住院花费降低,并在减少骨坏死、骨吸收和加速骨融合方面具有一定优势。

Objectives:To compare and analyze the clinical efficacy of muscle-pedicle open-door laminoplasty and traditional approach of lamina replantation with internal fixation in treating lumbar subdural extramedullary tumor.Methods:Retrospective analysis of the clinical data of 15 patients with lumbar subdural extramedullary tumor treated in the Department of Spine Surgery in the Shinan District of the Affiliated Hospital of Qingdao University from March 2016 to December 2018 was conducted.According to surgical methods,the patients were divided into two groups:group A of 7 patients receiving traditional approach of lamina replantation with internal fixation and group B of 8 patients receiving muscle-pedicle open-door laminoplasty.There was no significant difference in general data such as gender,age and tumor type between the two groups(P>0.05).The operative time,intraoperative blood loss,number of replanted or plastic laminae,length of hospitalization,inpatient cost,postoperative complications,and recurrence of tumor of the patients were recorded.The visual analog scale(VAS)and Oswestry disability index(ODI)were assessed at preoperation,1 week and 6 months after the operation,and the clinical efficacy was compared between the two groups.CT scans were performed to evaluate bone resorption and bone fusion at 7 days,3 months and 6 months postoperatively.Results:Both approaches provided sufficient exposure and complete resection of the tumor.Group A was followed up for 8.1±2.9 months and group B for 8.6±3.0 months,and no tumor recurrence occurred during the follow-up period.There was no statistically significant difference in operative time,intraoperative blood loss,number of replanted or plastic laminae,length of hospitalization between the two groups(P>0.05).The operative time and inpatient cost in group B were less than those in group A(P<0.05).The VAS scores and ODI of patients in both groups at 7d and 6 months after operation were significantly lower than those before operation(P<0.05),while there was no significant difference between the two groups(P>0.05).One patient of group B had big toe hyperesthesia which disappeared in a week,and one patient of group A occurred cerebrospinal fluid leakage which was cured after symptomatic treatment.At 6 months after operation,the replanted laminae of all the 7 patients in group A were fused incompletely,on the contrary to complete bone fusion on the muscle-pedicle side of the lamina of the eight patients in group B;and postoperative bone resorption was observed in all 7 patients of group A,while none was found in group B.Conclusions:Both muscle-pedicle open-door laminoplasty and traditional approach of lamina replantation with internal fixation can achieve good clinical results in the treatment of subdural extramedullary tumor.Muscle-pedicle open-door laminoplasty features less operative time and less inpatient cost,which also has some advantages in avoiding bone necrosis,bone resorption,and accelerating bone fusion.