椎管内肿瘤切除椎管解剖重建△

Anatomical reconstruction of spinal canal after intraspinal tumor resection

摘要:

［目的］探讨椎管内肿瘤切除术中椎管解剖重建的临床效果。［方法］2013 年 2 月—2017 年 5 月，对 48 例椎管内肿瘤摘除后行中央钛板重建椎管。评价临床与影像结果。［结果］所有患者均顺利完成手术，无严重并发症，随访（35.8±13.6）个月。术后随时间推移，VAS 与 ODI 评分显著减少（P<0.05），而 ASIA 评级显著改善提高（P<0.05）。影像方面，术后 1 周 MRI 见肿瘤均完全切除、硬脊膜减压充分。术后 3 个月 CT 三维重建见回植椎板骨质愈合良好，术后节段 ROM 及椎管面积较术前显著增加（P<0.05），无脊柱畸形、脊柱不稳或滑脱和肿瘤复发。［结论］ 椎管内肿瘤切除术中用中央钛板重建椎管可保持椎管容积， 维持脊柱骨-韧带结构完整。

Abstract:

[Objective] To investigate the clinical outcomes of anatomical reconstruction of spinal canal after intraspinal tumor resec- tion. [Methods] From February 2013 to May 2017, 48 patients underwent anatomical reconstruction of spinal canal with central piece plate secondary to intraspinal tumor resection. The clinical and imaging findings were evaluated. [Results] All the patients had operation complet- ed smoothly without serious complications, and were followed up for (35.8±13.6) months on an average. The VAS and ODI scores significant- ly decreased (P＜0.05) , while the ASIA neurological function grade significantly improved over time (P＜0.05) . Radiographically, all patients got tumors removed completely with sufficient dural decompression at 1 week after operation. Three months after operation, the CT three-di- mensional reconstruction showed that the re-implanted lamina healed well, and the segment ROM and spinal canal area significantly in- creased after operation (P＜0.05) , whereas no spinal deformity, spinal instability or spondylolisthesis and tumor recurrence were found in anyone of them. [Conclusion] Anatomical reconstruction of the spinal canal with central piece plate after intraspinal tumor resection does maintain the volume of the spinal canal and the integrity of the spinal bone-ligament structure.