椎管解剖学重建在胸椎椎管内病变手术中的应用

目的评估椎管解剖学重建在椎管内手术中的临床应用价值。方法 2012年10月至2014年1月我科收治的42例胸椎椎管内疾病患者采用后入路铣刀或微型咬骨钳沿双侧关节突内侧缘卸下一个或多个棘突椎板复合体,手术切除病变后,通过钛片钛钉连接回纳,重建胸椎椎管的解剖学结构。结果 42例患者的病变全部切除38例,次全切除4例,切除椎板数1∽4个,平均2.1个。2例手术过程中因铣刀头断裂改用微型咬骨钳,所有病例未出现硬脊膜破裂。术后随访3--16个月,平均12.4个月。三维CT复查见回植物固定良好,无椎管狭窄、畸形,骨性愈合,稳定性好。结论胸椎椎管解剖学重建方法简便,易于手术操作,对保持椎管的完整性,维持脊柱的稳定性,减少术后并发症有重要作用。

Anatomical reconstruction of spinal canal after surgery for thoracic intraspinal lesions

Objective To explore the value of the anatomical reconstruction of spinal canal to stabilizing spinal column after the surgery for thoracic intraspinal lesion. Methods The clinical date of 42 patients with thoracic intraspinal lesions who received laminoplasty after the resection of intraspinal lesions in our hospital from October, 2012 to January, 2014, were analyzed retrospectively. Of 42 patients with thoracic intraspinal lesions, 25 suffered from the tumors and 17 from the vascular malformations. One or several spinous processes and lamina complexes which were removed for resection of the intraspinal lesions were replanted in situ and fixed by titanium sheet after the resection of intraspinal lesions. Results Of 42 patients, 38 received total resection of the lesions and 4 subtotal. The number of the removed vertebral plates ranged from 1 to 4 （mean, 2.1） laminae. No dura mater spinalis was treated in all the patients. Three dimensional CT after the operation showed that no malunion, spinal stenosis and displacement or collapse of the replanted tissues occurred in all the patients. The patients were followed up for 3 tO 16 months （mean, 12.4 months）. There was good stability of spinal columns in all the patients in whom the neurological function was improved 3 months after the operation according to Frankel neurological function grading. Conclusions The anatomical reconstruction of the spinal canal after the thoracic intraspinal surgery is simple, practical, helpful to the spinal column stability and integrality, and reducing the postoperative complications.