两种不同术式治疗脊柱椎管肿瘤的疗效评价

目的探讨改良椎管扩大成形术和后路椎弓根螺钉固定术对脊柱椎管肿瘤病人围手术期指标、术后神经功能改善和脊柱稳定性的影响。方法选取128例脊柱椎管肿瘤病人的临床资料行回顾性分析，其中行改良椎管扩大成形术75例（A组），行后路椎弓根螺钉固定术53例（B组）。比较2组病人手术时间、术中出血量、术后脑脊液漏发生率等围手术期指标、术后3、6、12个月JOA评分、JOA评分改善率及脊柱不稳发生率。结果A组病人的手术时间、术中出血量、术后脑脊液漏发生率显著低于B组（P < 0.05~P < 0.01）。2组病人术后JOA评分显著增高（P < 0.01）；A组病人术后3、6、12个月JOA评分和JOA评分改善率显著低于B组（P < 0.01）。2组病人术后3、6、12个月腰椎不稳发生率差异无统计学意义（P>0.05）。结论相对后路椎弓根螺钉固定术，改良椎管扩大成形术可缩短脊柱椎管肿瘤病人的手术时间，减少术中出血量及术后脑脊液漏发生率。上述两种术式均具有较好的术后脊柱稳定效果，但后路椎弓根螺钉固定术创伤大、出血多，影响脊柱固定节段的活动度，临床上应根据病人具体情况选择最佳方案。

Clinical efficacy of two different surgical methods in the treatment of spinal canal tumors

ObjectiveTo investigate the effects of the modified expanding suspended laminoplasty and posterior pedicle screw fixation on the perioperative indicators, postoperative neurological function and spinal stability in patients with spinal canal tumors.MethodsThe clinical data of 128 patients with spinal canal tumors were retrospectively analyzed.Seventy-five were treated with the modified expanding suspended laminoplasty(group A), and 53 cases were treated with posterior pedicle screw fixation(group B).The operative time, intraoperative blood loss and incidence rate of postoperative cerebrospinal fluid leakage, and JOA score, JOA score improvement rate and spinal instability incidence after 3, 6 and 12 months of surgery were compared between two groups.ResultsThe operative time, intraoperative blood loss and incidence rate of postoperative cerebrospinal fluid leakage in group A were significantly lower than those in group B(P < 0.05 to P < 0.01).After operation, the JOA scores in two groups significantly increased(P < 0.01).After 3, 6 and 12 of operation, the JOA score and JOA score improvement rate in group A were significantly lower than those in group B(P < 0.01), and the differences of the incidence rate of spinal instability were not statistically significant between two groups(P>0.05).ConclusionsCompared with the posterior pedicle screw fixation, the modified expanding suspended laminoplasty can shorten the operation time, and reduce the amount of intraoperative bleeding and incidence rate of cerebrospinal fluid leakage of patients with spinal canal tumors.The two types of surgery have a good effect in stabilizing the spine after operation, but the posterior pedicle screw fixation has a large amount of trauma and bleeding, and affects the mobility of the spinal fixation segment.The best choice should be chosen according to the patient's specific situation.