CAJ | 학술논문

目的：经全椎板入路手术对脊柱骨性结构破坏大，影响其稳定性。文中探讨不同节段的椎板切除对腰椎椎管内肿瘤术后脊柱稳定性的影响。方法对2009年1月至2012年6月在广西医科大学一附院、广西中医药大学瑞康医院、广西中医药大学一附院、广西区骨伤医院、柳州市人民医院、柳州市工人医院等6家医院进行手术治疗的143例腰椎椎管内肿瘤病例临床资料进行回顾性分析，所有病例均行全椎板切除肿瘤摘除术，且术中无内固定器械的使用。近期临床疗效采用JOA括约肌评分，远期临床疗效采用ASIA分级评估。比较术前和最后1次随访病例腰椎的稳定性。结果近期临床疗效观察，JOA括约肌评分从（1．12±0．65）分提升到（1．97±0．71）分。远期临床疗效观察，ASIAⅠ级4例，Ⅱ级6例，Ⅲ级14例，Ⅳ级53例，Ⅴ级66例。随访12～30个月，无失访病例。末次随访1个节段的全椎板切除45例，有2例病例出现脊柱失稳；2个节段的全椎板切除57例，有9例失稳；3个节段的全椎板切除27例，有5例失稳；4个节段的全椎板切除14例，有2例失稳。比较脊柱术后稳定性和推板切除节段数，1个阶段的推板切除术后脊柱稳定性明显高于多节段的稳定性，差异有统计学意义（P＝0．047）。≤2个节段椎板切除与≥3个节段椎板切除稳定性差异无统计学意义（P＝0．305），≤3个节段椎板切除与≥4个节段椎板切除差异无统计学意义（P＝1．000）。结论单一节段的腰椎椎管内肿瘤全椎板切除术后稳定性良好，≥2个节段的椎管内肿瘤单纯行全椎板切除肿瘤摘除术，术后脊柱失稳的可能性大。
목적：경전추판입로수술대척주골성결구파배대，영향기은정성。문중탐토불동절단적추판절제대요추추관내종류술후척주은정성적영향。방법대2009년1월지2012년6월재엄서의과대학일부원、엄서중의약대학서강의원、엄서중의약대학일부원、엄서구골상의원、류주시인민의원、류주시공인의원등6가의원진행수술치료적143례요추추관내종류병례림상자료진행회고성분석，소유병례균행전추판절제종류적제술，차술중무내고정기계적사용。근기림상료효채용JOA괄약기평분，원기림상료효채용ASIA분급평고。비교술전화최후1차수방병례요추적은정성。결과근기림상료효관찰，JOA괄약기평분종（1．12±0．65）분제승도（1．97±0．71）분。원기림상료효관찰，ASIAⅠ급4례，Ⅱ급6례，Ⅲ급14례，Ⅳ급53례，Ⅴ급66례。수방12～30개월，무실방병례。말차수방1개절단적전추판절제45례，유2례병례출현척주실은；2개절단적전추판절제57례，유9례실은；3개절단적전추판절제27례，유5례실은；4개절단적전추판절제14례，유2례실은。비교척주술후은정성화추판절제절단수，1개계단적추판절제술후척주은정성명현고우다절단적은정성，차이유통계학의의（P＝0．047）。≤2개절단추판절제여≥3개절단추판절제은정성차이무통계학의의（P＝0．305），≤3개절단추판절제여≥4개절단추판절제차이무통계학의의（P＝1．000）。결론단일절단적요추추관내종류전추판절제술후은정성량호，≥2개절단적추관내종류단순행전추판절제종류적제술，술후척주실은적가능성대。
Objective Laminectomy is destructive to bone structure in spine , which affect spinal stability .This article was to investigate the effect on spinal stability after laminectomy in different segments of vertebral plate in the treatment of lumbar intraspinal tumors. Methods Retrospective analysis were made on the data of 143 patients with lumbar intraspinal tumors from January 2009 to June 2012 in 6 hospitals.All the patients underwent laminectomy with no use of inner regular apparatus during the operation .JOA evalu-ation was applied to observe short-term efficacy , while ASIA scale for long-term efficacy .Comparison was made on lumbar spinal stability before operation and in the last visiting . Results From the observation of short-term efficacy, JOA evaluation score rised from (1.12 ± 0.65)to (1.97 ±0.71).Form the observation of long-term efficacy, ASIA scale classification was as follows:4 cases of Grade I, 6 cases of Grade II, 14 cases of Grade III, 53 cases of Grade IV and 66 cases of Grade V.In the following 12-30 months′visiting, all patients were covered.In the last postoperative visiting, patients suffering spinal instability after laminectomy were as follows:2 of 45(one seg-ment), 9 of 47(two segments), 5 of 27 (three segments) and 2 of 14 (four segments).From the observation on the postoperative spinal sta-bility and the segments in laminectomy , spinal stability of one-segment group was significantly higher than that of multi-segment group ( P=0.047).No significant difference exist between the groups of less than 2 segments and more than 3 segments as well as the groups of less than 3 segments and more than 4 segments. Conclusion A single seg-ment laminectomy on lumbar intraspinal tumors showed good postopera-tive spinal stability .But laminectomy in two or more segments implied greater risk of postoperative spinal instability .