椎板棘突韧带复合体复位技术在椎管肿瘤术中应用的对比性分析(附62例分析)

doi:10.19854/j.cnki.1008-2425.2023.05.0009

摘要/Abstract

摘要： 目的分析椎板棘突韧带复合体复位技术在椎管肿瘤术中临床应用的价值,探讨影响椎板棘突韧带复合体愈合的可能原因和远期预后。方法回顾性分析同一治疗组主刀医师根据手术指征和患者意愿等因素采用不同术式的三组病例的住院时间、费用、并发症、患者心理感受对比以及术后医从性差别对于椎板棘突韧带复合体愈合和预后的影响。结果三组共计62例患者,在2018年1月至2019年4月间在椎管肿瘤切除后分别给予去椎板减压23例,椎板棘突韧带复合体复位固定39例、其中椎板棘突韧带复合体复位固定加自体骨屑植骨19例。随访12月以上椎板复位加自体骨屑回植19例中骨性愈合5例、死骨吸收3例、未愈合14例,后凸畸形1例,局部软组织疼痛2例;单纯椎板复位20例中骨性愈合5例、死骨吸收3例、未愈合15例,后凸畸形1例,局部软组织疼痛3例;去椎板减压患者23例出现不同程度的局部疤痕黏连、其中椎管狭窄7例,局部疤痕骨化4例,轻度后凸畸形5例,局部软组织疼痛13例。结论椎板棘突复合体复位对于椎管肿瘤术后患者明显消除局部疤痕粘连形成,疼痛反应减少,对于脊柱畸形短时间内存在帮助。但是复位骨质愈合率低,断骨残端植骨有一定帮助,总体效果欠佳。患者从该术式明显获益,临床仍然需要推广。

关键词: 椎板棘突复位, 椎管肿瘤, 骨性愈合, 脊柱稳定性, 预后

Abstract: Objective To analyze the clinical application value of the reduction technique of the lamina spinous process ligament complex in the operation of spinal canal tumors,and to explore the possible causes and long-term prognosis affecting the healing of the lamina spinous process ligament complex.Methods The effects of hospital stay,cost,complications,psychological feelings of patients and postoperative compliance on the healing and prognosis of the lamina spinous process ligament complex were analyzed retrospectively.Results From January 2018 to April 2019,23 patients were given laminectomy and decompression,39 patients were given reduction and fixation of spinous process ligament complex,and 19 patients were given reduction and fixation of spinous process ligament complex and autologous bone graft.Follow-up was over 12 months,in 19 cases of laminectomy and autogenous bone chips replantation,5 cases of bone healing,3 cases of dead bone resorption,14 cases of nonunion,1 case of kyphosis and 2 cases of local soft tissue pain ;in 20 cases of laminectomy alone,5 cases of bone healing,3 cases of dead bone resorption,15 cases of nonunion,1 case of kyphosis and 3 cases of local soft tissue pain were followed up;23 cases of laminectomy patients had different degrees of local scar adhesion and local pain There were 7 cases of middle spinal canal stenosis,4 cases of local scar ossification,5 cases of mild kyphosis and 13 cases of local soft tissue pain.Conclusion The reduction of lamina spinous process complex can significantly eliminate the formation of local scar adhesion and reduce local pain reaction in patients with spinal canal tumor after operation,which is helpful for spinal deformity in a short time.However,the bone healing rate of reduction is low,and bone grafting at the broken bone stump is helpful,and the overall effect is not good.Patients benefit from the operation,and it still needs to be popularized.

Key words: Reduction of spinous process of lamina, Spinal canal tumor, Bone healing, Spinal stability, Prognosis

中图分类号:

R739.47

王林, 曾明慧, 何芳, 徐昊, 杨涛. 椎板棘突韧带复合体复位技术在椎管肿瘤术中应用的对比性分析(附62例分析)[J]. 立体定向和功能性神经外科杂志, 2023, 36(5): 304-308.

Wang Lin, Zeng MingHui, He Fang, et al. Comparative analysis of the vertebral plate and ligament composite laminoplasty in spinal cord tumor surgery:analysis of 62 cases[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(5): 304-308.

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