张占阅 张安龙 梅小龙 侯晓峰 赵志军 张春阳

[摘要] 目的 探討椎管内肿瘤切除术中行椎板成形术的疗效。 方法 回顾性分析在我院2013年1月～2017年1月行椎管内肿瘤手术患者的病例，其中椎板成形组15例，非椎板成形组（全椎板切除）25例，比较两组术式的手术时间、术中出血量、术后平均住院时间、术后脊柱不稳、术后神经功能恢复程度及术后并发症。 结果 两组手术时间、术中出血量、住院时间对比，差异无统计学意义（P>0.05）;两组在术后并发症方面，在脑脊液漏发生率、术后感染发生率比较未见明显差异（P>0.05）。但术后脊柱不稳发生率对比差异有统计学意义（P<0.05）;椎板成形组和非椎板成形组术后JOA（日本骨科学会，Japanese orthopaedic association，JOA）评分均比术前有明显改善。但椎板成形组术后JOA评分改善率比非椎板成形组高。 结论 椎板成形术治疗椎管内肿瘤实现了脊柱的解剖复位，相对地确保了脊柱的完整性，在一定程度上减少了脊柱不稳的发生。同时椎板成形组的术后JOA评分改善率也比非椎板成形组的高，故椎板成形术治疗椎管内肿瘤值得临床推广。

[关键词] 椎管肿瘤;椎板成形;脊柱不稳;手术;脑脊液漏;感染

[中图分类号] R739.42          [文献标识码] A          [文章编号] 1673-9701（2020）17-0008-03

A study of the clinical application of laminoplasty in the treatment of intraspinal tumors

ZHANG Zhanyue1， 2   ZHANG Anlong1， 2   MEI Xiaolong1， 2   HOU Xiaofeng1， 2   ZHAO Zhijun1， 2   ZHANG Chunyang1， 2

1.The First Affiliated Hospital of Baotou Medical College， Inner Mongolia University of Science and Technology， Baotou 014010， China; 2.Inner Mongolia Autonomous Region Bone Tissue Regeneration and Injury Repair Engineering Technology Center， Baotou   014010， China

[Abstract] Objective To investigate the therapeutic effect of laminoplasty in the resection of intraspinal tumors. Methods A retrospective analysis was made on the cases of patients undergoing intraspinal tumor operation in our hospital from January 2013 to January 2017， including 15 cases in the laminoplasty group and 25 cases in the non-laminoplasty group（total laminectomy）. The operation time， intraoperative hemorrhage， postoperative average hospitalization time， postoperative spinal instability， postoperative neurological function recovery degree and postoperative complications of the two groups undergoing different operations were compared. Results There was no statistically significant difference in operation time， intraoperative hemorrhage and hospitalization time between the two groups（P>0.05）. There was no significant difference in the incidence of cerebrospinal fluid leakage and of postoperative infection between the two groups in terms of postoperative complications（P>0.05）. However， the incidence of postoperative spinal instability was different between the two groups with statistical significance（P<0.05）. The postoperative Japanese Orthopedic Association（JOA） scores of the laminoplasty group and the non-laminoplasty group were significantly improved when compared with those before operation， and the improvement rate of postoperative JOA scores in the laminoplasty group was higher than that in the non-laminoplasty group. Conclusion Laminoplasty for the treatment of intraspinal tumors can achieve anatomical reduction of the spine and relatively ensure the integrity of the spine， thus reducing the occurrence of spinal instability to a certain extent. Meanwhile， the improvement rate of postoperative JOA scores in laminoplasty group is higher than that in non-laminoplasty group. Laminoplasty for the treatment of intraspinal tumors is worthy of clinical promotion.

本组病例先全椎板切除，以便充分暴露肿瘤及周边组织，保证术中切除腫瘤的安全性。严密缝合硬膜，使椎管内膜性组织尽量恢复完整性，达到减少脑脊液漏发生的目的。减少颅内感染的风险及皮肤伤口的愈合。然后以钛板、钛钉固定去除的棘突和椎板，解剖复位，保证骨性的完整性。这有利于骨组织及软组织的修复，避免发生医源性椎管狭窄的并发症[16]。最后缝合椎管外软组织，尤其是肌肉、韧带及筋膜组织。本组例数尚少，对于单节段与多节段的术后效果需进一步研究证实。

综上所述，椎板成形术治疗椎管内肿瘤实现了脊柱的解剖复位，相对地确保了脊柱的完整性，在一定程度上减少了脊柱不稳的发生。同时椎板……