保留棘上韧带连续性的椎板回植术在治疗腰椎管内良性肿瘤中的应用

Treatment of benign tumors in the lumbar spinal canal by recapping laminoplasty preserving the continuity of superior spinous ligament

目的探讨保留棘上韧带连续性的椎板回植技术在治疗腰椎管内良性肿瘤中的疗效。方法回顾性分析自2018年3月至2020年3月在漯河市中心医院脊柱骨科行保留棘上韧带连续性的椎板回植技术治疗的23例腰椎管内良性肿瘤患者资料。术后所有患者随访12~23个月,采用末次随访时日本骨科协会(JOA)评分进行疗效评价。采用X线片、CT及MRI结果进行影像学评价。结果23例患者人均回植椎板数1~4个,平均2.2个。手术时间为(77.2±22.7)min,范围为67~146 min;术中出血量为(127.0±32.6)mL,范围为90~290 mL。所有患者肿瘤均切除完整,术后2例出现脑脊液漏,经补充电解质及切口局部加压处理后切口愈合。未出现脊髓损伤、硬膜外血肿、感染等相关并发症。患者末次随访时的JOA评分升至(23.22±2.47)分,与术前[(11.85±1.38)分]比较差异有统计学意义(t=18.505,P<0.001)。其中疗效优10例、良9例、中4例,优良率为82.6%。影像学指标方面,末次随访时腰椎前曲角(LLA)为(51.58±2.39)°,与术前[(52.24±3.17)°]比较差异无统计学意义(t=0.672,P=0.505)。影像学结果示肿瘤未复发,同时腰椎无滑脱不稳、椎板无移位、椎管容积未缩小。结论采用保留棘上韧带连续性的椎板回植技术治疗腰椎管内良性肿瘤可恢复腰椎管的正常解剖结构,具有无骨量丢失、术后腰椎曲度维持良好的优点。

Objective To investigate the efficacy of recapping laminoplasty preserving the continuity of superior spinous ligament in the treatment of benign tumors in the lumbar spinal canal.Methods A retrospective analysis was performed.The clinical data of 23 patients with benign tumors in lumbar spinal canal,admitted to our hospital from March 2018 to March 2020,were collected.Follow up was performed for 12-23 months;Japanese Orthopaedic Association(JOA)scores were used for efficacy evaluation.X-ray,CT and MRI were used for imaging evaluation.Results The number of replanted lamina was 1-4,with an average of 2.2.The surgical duration was(77.2±22.7)min,ranged from 67 min to 146 min;and the amount of intraoperative bleeding was(127±32.6)mL,ranged from 90-290 mL.The tumors were completely removed in all patients,and there were 2 patients complicated with cerebrospinal fluid leakage,and the wound healed after electrolyte supplement and local pressure treatment.No spinal cord injury,epidural hematoma,infection or other related complications were noted.The JOA scores increased from 11.85±1.38 before surgery to 23.22±2.47 at the last follow-up,with significant difference(t=18.505,P<0.001).Of them,10 had excellent efficacy,9 had good efficacy,and 4 had medium efficacy,enjoying an excellent and good rate of 82.6%.Lumbar lordosis angle(LLA)was(51.58±2.39)°at the last follow-up,which showed no significant difference as compared with the preoperative LLA([52.24±3.17]°,t=0.672,P=0.505).Imaging results showed that there was no spondylolisthesis or instability of lumbar spine,no recurrence of tumors was noted,and no displacement of lamina or secondary reduction of spinal canal volume were noted.Conclusion The treatment of benign tumors in lumbar spinal canal by modified recapping laminoplasty preserving the continuity of superior spinous ligament can restore the normal anatomical structure of lumbar spinal canal,achieve no bone loss and maintain lumbar curvature well.