棘突椎板切开复位并植骨融合术在椎管内肿瘤手术中的应用

Evaluation of replantation of spinous process and lamina and autogenous bone fusion after resection of intraspinal tumors

目的探讨棘突椎板复位联合植骨融合术在椎管内肿瘤切除术中的应用价值。方法共22例椎管内肿瘤患者(颈椎5例、胸椎5例、腰椎12例),均经脊柱后正中入路行显微手术,切取病变区域2~3个节段的棘突椎板、全切除肿瘤、棘突椎板复合体复位、钛连接片固定和棘突椎板间隙植骨融合以恢复椎管解剖结构和脊柱稳定性。采用日本矫形外科学会评分标准评价手术前后脊髓功能。结果肿瘤全切除率达100%,切除2~3个节段(平均2.50个)。术后随访3~17个月(平均10个月),影像学(X线、三维CT重建和MRI)观察棘突椎板复位连续性,可见植骨后部分达骨性融合,未发现椎管狭窄及椎管瘢痕粘连压迫硬脊膜等术后并发症。结论棘突椎板切开复位联合植骨融合术能够保持脊柱解剖结构的完整性,重建椎管结构、保持脊柱稳定性,减少经脊柱后路手术瘢痕增生、粘连对脊髓的压迫。

Objective To evaluate the replantation of lamina and spinous process and autogenous bone fusion after resection of intraspinal tumors. Methods Twenty two cases of intraspinal canal tumors, including 5 cervical, 5 thoracic and 12 lumbar, were operated through posterior median approach with removing 2-3 segments of spinous process and lamina complex in the lesion area. During operation, the spinous process and lamina complex was replanted in situ after the intraspinal tumor was removed, and was fixed by titanium bar and titanium screw, along with autogenous bone fusion to restore the normal anatomy of spinal canal. Japanese Orthopedic Association(JOA) scale was used to evaluate the spinal function before and after operation. Results Tumors were totally removed in all of the cases, and 2-3(2.50 on average) laminae were removed in each case. After 3-17 months(10 months on average) follow up, imaging findings showed good reposition of replanted lamina and spinous process with partly bony fusion in all cases. No syndromes of spinal stenosis or compression on spinal dura mater owing to canal cicatrix were seen. Conclusion Replantation of lamina and spinous process and autogenous bone fusion can keep the anatomic integrality of the spine, reconstruct the spinal canal structure, maintain the spinal stability and avoid nerve root compression due to spinal canal scar.