棘突椎板切开复位在成人椎管内肿瘤术中应用

目的 探讨成人椎管内肿瘤术中棘突椎板切开复位术应用效果.方法 经后正中入路行椎管内肿瘤切除18 例,术中将相应病变节段棘突、棘上韧带、棘间韧带、椎板整体切割取下,切除椎管内肿瘤后,整体原位回植棘突椎板,钛片-钛钉固定,完成椎管成形.结果 18 例病人中棘突椎板切开复位节段2 ～ 6 节段(平均3.8 节段),肿瘤全切17 例,全切率94.4%.所有病例术野显露满意,脊髓或神经根损伤均未加重,术后7 ～10 d 摄X 线片观察,棘突椎板均恢复原位连续性.随访复查MRI、X 线片,回植的组织均无移位,全部骨性愈合.结论 该术式解剖性地重建椎管结构,术后能保持脊柱的稳定性,减少术后并发症的发生.

Application of osteotomy and regrafting in situ with spinous process and vertebral plate in spinal cord tumor surgery of adults

Objective To evaluate the effectiveness and biomechanical stability of the operation used for adult spinal cord tumors resection. Methods A series of 18 patients with spinal cord tumors were removed through posterior approach. During the operation,the para-vertebral muscle above the dorsal spine with preserving supraspinal ligament and interspinal ligaments was departed. After the tumor resection,the structure were replaced back to its previous position and fixed with titanium miniplates. Results A mean of 3.8 laminae levels （range from 2 to 6 levels） were exposed and reconstructed and 94.4% of the tumors were totally removed. Spinal cord or nerve roots was not found aggravative injury after operation. Spinous process and vertebral plate recovered well in situ,displacement was not found in osteotomy region by X-ray 7 - 10 days after operation. All the follow-up patients received MRI and X-ray examination. Conclusion The technique can fully expose the spinal canal, keep anatomic structure of spinal canal and the stability of spine kept with a low complication rate.