摘要
为了探讨经带肌蒂的单开门椎板成形入路切除胸椎管内髓外硬膜下肿瘤的疗效,回顾性分析2018年12月至2021年6月青岛大学附属医院市南院区脊柱外科收治的15例胸椎管内髓外硬膜下肿瘤患者的临床资料,所有患者均采用经带肌蒂的单开门椎板成形术切除肿瘤。记录每例患者临床资料和手术前后日本骨科协会(JOA)评分、站立位胸椎后凸角以及术后胸背切口疼痛视觉模拟评分(VAS)情况,术后3个月、末次随访均行CT检查了解成形椎板愈合情况,同时末次随访通过MRI了解后方韧带愈合情况。15例患者肿瘤均顺利完整切除,手术时间(91±15)min,出血量(117±56)ml。其中3例患者出现脑脊液漏,经加压包扎后均顺利愈合且未出现相关并发症。所有患者均随访6个月以上。术后3 d胸背切口疼痛VAS评分为(3.0±1.3)分,术后3个月为(1.3±0.9)分(P<0.001);术前JOA评分为(11.9±2.4)分,术后3个月为(14.0±1.6)分,末次随访为(16.1±0.7)分,术后均优于术前(均P<0.001);术前Cobb角为10.1°±5.3°,末次随访时为10.4°±6.2°,差别无统计学意义(P=0.420)。所有患者术后3个月CT显示椎板门轴侧(带肌蒂侧)均见部分骨痂形成甚至完全愈合,末次随访时CT显示椎板门轴侧均完全愈合,开门侧见不同程度硬化或愈合表现,椎板均未出现坏死、明显移位和继发性椎管狭窄。可见通过带肌蒂的单开门椎板成形手术入路切除胸椎管内髓外硬膜下肿瘤疗效确切。
In order to evaluate the efficacy of resecting extramedullary subdural tumors,located in the thoracic spinal canal,via the muscle-pedicle open-door laminoplasty approach,clinical data of fifteen patients with thoracic spinal tumors admitted to the Department of Spinal Surgery in the Affiliated Hospital of Qingdao University from December 2018 to June 2021 were analyzed retrospectively.All patients received surgical treatment to remove the tumors via the muscle-pedicle open-door laminoplasty approach.The clinical data of the patient was recorded.The Japanese Orthopedic Association(JOA)score,the thoracic kyphosis angle in the standing position before and after the operation,and the visual analog score(VAS)of thoracic back incision pain before and after the operation were compared.CT scan was performed three months after the surgery and at the last follow-up to measure the healing of the lamina.In addition,MRI was used to detect the healing of the posterior ligament at the last follow-up.The tumors of all fifteen patients were completely removed,the operating time was(91±15)minutes,blood loss was(117±56)ml.Cerebral spinal fluid leakage occurred in three patients,but the incisions healed smoothly following compression and no complication was observed.All patients were followed-ups for more than 6 months.The VAS score of thoracic back incision pain was(3±1.3)points at three days post operation and it dropped to(1.3±0.9)points three months post-operation.The JOA score improved significantly after the operation,it was(11.9±2.4)points before operation,and it was(14.0±1.6)points three months post operation and increased to(16.1±0.7)points at the last follow-up(both P<0.001).The Cobb angle was 10.1°±5.3°before the operation and it was 10.4°±6.2°at the last follow-up(P=0.420).Three months after operation,partial callus formation or even complete healing on the muscle pedicle side was observed on the CT scans of all patients.At the last follow-up,CT scans showed complete healing on the muscle pedicle side.There were different degrees of sclerosis and healing on the open-door side.There was no necrosis,displacement,or secondary spinal canal stenosis in any vertebral lamina.It indicated that the muscle-pedicle open-door laminoplasty approach is an effective way to resection extramedullary subdural tumors located in the thoracic spinal canal.
作者
仲盛惟
李田米
别永晨
寇建强
柳翔云
孙元亮
郑修军
Zhong Shengwei;Li Tianmi;Bie Yongchen;Kou Jianqiang;Liu Xiangyun;Sun Yuanliang;Zheng Xiujun(Department of Spinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Operating Room,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第9期696-699,共4页
National Medical Journal of China
关键词
胸椎
胸椎管内肿瘤
带肌蒂
单开门
椎板成形
Thoracic vertebrae
Thoracic intraspinal tumor
Muscle pedicle
Open door
Laminoplasty
作者简介
通信作者:郑修军,Email:zhengxiuj@qduhospital.cn
