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目的椎管内肿瘤全椎板减压术是椎管内肿瘤摘除的常规手术方式,术后易造成椎管内粘连导致椎管再次狭窄引起一系列的并发症,造成2次手术困难,本文对这一术式进行改良,采用后路钛网椎管成形对所减压的椎管进行修复重建,恢复椎管内有效容积、减少粘连。方法 2007年10月至2011年2月共收治9例胸椎椎管内肿瘤的患者,男6例,女3例,年龄25～64岁,平均37.8岁。硬膜外肿瘤5例,硬膜内肿瘤4例。全部给予后路全椎板减压,肿瘤切除,椎弓根钉内固定并钛网椎管成形术。术后病理学诊断:神经鞘瘤3例,脊膜瘤2例,脂肪瘤2例,囊肿2例。肿瘤复发1例,给予2次手术切除后未复发。结果手术时间90-185min,平均142min,失血量200～1200ml,平均521ml,全部9例患者术后得到定期随访12-45个月,平均21个月。采用Frankel评分标准对术后患者症状进行评价,A:0例,B:1例,C:3例,D:2例,E:3例。术后复发1例。术后CT显示椎管内未出现粘连。对术前术后肿瘤占位所在节段椎管横截面CT图片进行分析,每例患者随机取5个横截面进行椎管内矢状径测量,取平均值,术前矢状径为16.89±1.27mm,术后矢状径为27.11±2.52mm,进行配对t检验,t=-15.441,P<0.01,术后椎管矢状径明显大于术前。结论后路钛网椎管成形手术难度相对较低,减少手术时间,降低术中出血量,术后对椎管起到较好的即刻保护作用,同时增加了术后椎管容积,减少了术后粘连,为肿瘤复发后的2次手术剥离减少风险。
Objective spinal canal full laminar decompression surgery is a routine surgical removal of spinal canal tumor, easily lead to spinal canal adhesions lead to spinal stenosis again caused a series of complications, resulting in 2 surgical difficulties, this article This procedure was improved, the use of posterior titanium mesh vertebral tube decompression of the spinal canal repair and reconstruction, restoration of effective volume within the spinal canal, reduce adhesions. Methods From October 2007 to February 2011, 9 patients with thoracic spinal canal tumors were treated. There were 6 males and 3 females, aged from 25 to 64 years (average 37.8 years). Epidural tumors in 5 cases, 4 cases of intradural tumors. All given posterior full laminar decompression, tumor resection, pedicle screw fixation and titanium mesh vertebroplasty. Postoperative pathological diagnosis: Schwannoma in 3 cases, 2 cases of meningioma, lipoma in 2 cases, 2 cases of cysts. Tumor recurrence in 1 case, given 2 times without recurrence after resection. Results The operation time was 90-185min with an average of 142min and the blood loss was 200 ~ 1200ml with an average of 521ml. All 9 patients were followed up for 12-45 months (average 21 months). The postoperative symptoms were evaluated using the Frankel scale. A was 0, B was 1, C was 3, D was 2, and E was 3. Recurrence after surgery in 1 case. Postoperative CT showed no adhesions in the spinal canal. Preoperative and postoperative tumor mass segment of the spinal canal cross-sectional CT images were analyzed, each patient were randomly selected 5 cross-section of the spinal canal sagittal measurement, mean, preoperative sagittal diameter was 16.89 ± 1.27mm, sagittal diameter was 27.11 ± 2.52mm, paired t-test, t = -15.441, P <0.01, postoperative spinal canal sagittal diameter was significantly larger than preoperative. Conclusions The difficulty of posterior titanium mesh vertebroplasty is relatively low, which can reduce the operation time and reduce the amount of intraoperative blood loss. After operation, it plays an immediate role in the protection of the spinal canal. At the same time, it increases the volume of postoperative spinal canal and reduces the operation time Post-adhesions, reduce the risk of 2 surgical stripping after tumor recurrence.