中国修复重建外科杂志

中国修复重建外科杂志

超声骨刀在椎管内肿瘤切除椎管成形术中的应用

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目的 探讨超声骨刀在椎管内肿瘤切除后椎管成形中的实用性及安全性。 方法 回顾分析 2015 年 12 月—2017 年 4 月采用超声骨刀行椎管内肿瘤切除后椎管成形术治疗的 17 例胸腰椎椎管内肿瘤患者临床资料。患者均为男性;年龄 42~73 岁,平均 57.4 岁。病程 2~47 个月,平均 21.1 个月。其中胸椎管内肿瘤 4 例(T10 1 例、T12 2 例),腰椎管内肿瘤 13 例(L1 5 例、L2 4 例、L3 2 例、L4 2 例)。术后病理诊断为神经鞘瘤 8 例,脊膜瘤 4 例,神经纤维瘤 2 例,皮样囊肿 2 例,室管膜瘤 1 例。术前按 Frankel 分级标准评估脊神经功能,B 级 2 例,C 级 7 例,D 级 8 例。术中实时记录应用超声骨刀进行单个节段椎管后壁切开的时间、整体手术时间、术中出血量、术中有无硬脊膜损伤及脑脊液漏、有无脊髓及神经根损伤;术后 3~6 个月根据 MRI、CT 三维重建观察肿瘤情况及骨愈合情况,并采用 Frankel 分级评价脊神经功能。 结果 患者应用超声骨刀进行单个节段椎管后壁切开的时间为 3.4~5.7 min,平均 4.1 min;整体手术时间 135~182 min,平均 157.3 min;术中出血量 300~500 mL,平均 342.6 mL。术中无意外性硬脊膜损伤及脑脊液漏发生,无神经根损伤和脊髓损伤发生。术后切口均Ⅰ期愈合。17 例患者均获随访,随访时间 9~18 个月,平均 12.7 个月。MRI 检查未见肿瘤复发,CT 三维重建示所有患者骨质愈合良好。随访期间无内固定物松动、断裂情况,未见脊髓再受压等情况。末次随访时 Frankel 分级为 B 级 1 例,C 级 5 例,D 级 7 例,E 级 4 级。 结论 应用超声骨刀系统进行肿瘤切除后椎管成形术,可保留脊柱后柱骨-韧带结构的完整性,保持椎管容积,操作安全性高、实用性强,术后效果好。

Objective To explore the practicability and safety of ultrasonic bone curette in the laminoplasty of spinal canal after resection of intraspinal tumors. Methods The clinical data of 17 patients with thoracolumbar intraspinal tumors treated with ultrasonic bone curette after resection of intraspinal tumors between December 2015 and April 2017 were retrospectively analyzed. All patients were male, aged from 42 to 73 years old, with an average of 57.4 years old. The disease duration was 2 to 47 months, with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors (T10 in 1, T12 in 2) and 13 cases of lumbar intrathoracic tumors (L1 in 5, L2 in 4, L3 in 2, and L4 in 2). Postoperative pathological diagnosis showed that 8 cases was schwannoma, 4 cases was meningioma, 2 cases was neurofibroma, 2 cases was dermoid cyst, and 1 case was ependymoma. Spinal nerve function was evaluated preoperatively according to Frankel classification criteria, with 2 cases of grade B, 7 cases of grade C, and 8 cases of grade D. During the operation, the time of single segmental vertebral canal posterior wall incision, the overall operation time, intraoperative blood loss, intraoperative dural injury, and cerebrospinal fluid leakage, spinal cord and nerve root injury were recorded. At 3-6 months after operation, the tumor and bone healing were observed according to MRI and CT three-dimensional reconstruction, and the spinal nerve function was evaluated by Frankel classification. Results The time of ultrasonic osteotomy for the posterior wall of a single segmental vertebral canal was 3.4-5.7 minutes, with an average of 4.1 minutes. The overall operation time was 135-182 minutes, with an average of 157.3 minutes. The intraoperative blood loss was 300-500 mL, with an average of 342.6 mL. There was no accidental dural injury and cerebrospinal fluid leakage, no nerve root injury and spinal cord injury. The incision healed by first intention after operation. All the 17 patients were followed up 9-18 months, with an average of 12.7 months. MRI examination showed no tumor recurrence, and CT three-dimensional reconstruction showed good bone healing in all patients. During the follow-up period, there was no loosening or rupture of the internal fixator and no re-compression of the spinal cord. At last follow-up, according to Frankel classification, there were 1 case as grade B, 5 cases as grade C, 7 cases as grade D, and 4 cases as grade E. Conclusion The application of ultrasonic bone curette in laminoplasty of spinal canal after resection of intraspinal tumors can preserve the integrity of the bone ligament structure of posterior column, maintain the volume of vertebral canal, and has high safety, practicability, and good postoperative effecteveness.

关键词: 超声骨刀; 脊柱肿瘤; 椎管成形

Key words: Ultrasonic bone curette; spinal tumor; laminoplasty

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