摘要目的 探讨旁正中椎板切开复位术治疗腰椎椎管内肿瘤的可行性及有效性.方法 回顾性分析2016年10月至2018年5月扬州大学临床医学院神经外科采用旁正中椎板切开复位术治疗的15例腰椎椎管内肿瘤患者的临床资料.观察术中出血量、手术时间、肿瘤切除情况、手术相关并发症等;采用日本骨科学会(JOA)下腰痛评分标准评价脊髓神经功能改善情况,并随访肿瘤复发、脊柱稳定性及椎板愈合情况.结果 15例患者腰椎椎管内肿瘤均为完全切除,手术出血量为(95.3±58.2) ml,手术时间为(176.7±35.2) min.15例患者术后病理学诊断为神经鞘瘤13例,转移性低分化腺癌1例,黏液乳头型室管膜瘤1例.患者术前JOA下腰痛评分为(15.5±4.9)分,术后为(24.0±3.5)分,差异有统计学意义(P＜0.01);未发生手术相关并发症;CT检查显示,椎板复位良好,无椎弓根、椎体骨折.术后随访6～18(10.8±3.9)个月,所有患者均无肿瘤复发,无脊柱变形;CT检查显示术区椎板骨缝趋于愈合.结论 旁正中椎板切开复位术对脊柱后方张力带损伤小,有利于保护脊柱稳定性,应用于腰椎椎管内肿瘤切除手术,技术可行,效果良好.

abstractsObjective To explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar spinal canal tumors.Methods We retrospectively reviewed the clinical data of 15 patients with lumbar spinal canal tumors who underwent tumor resection following para-split laminotomy at Department of Neurosurgery,Clinical Medical College of Yangzhou University from October 2016 to May 2018.Observation indicators included intraoperative blood loss,surgical duration,tumor resection,tumor pathological results and complications.Neurological functions of the spinal cord evaluated based on JOA (Japanese Orthopedic Association) scoring system.The follow-up situations included tumor recurrence,spinal stability evaluation and bone fusion of laminae.Results All lumbar spinal canal tumors were resected completely.The mean blood loss was 95.3 ±58.2 ml and the mean duration of the surgical procedure was 176.7 ±35.2 min.In this group,the average preoperative JOA score was 15.5 ±4.9 and the average postoperative JOA score was 24.0±3.5,which was improved significantly (P ＜ 0.01).There were no operative complications occurring.The CT examination showed no pedicle or vertebral fractures.During the follow-up period of 6-18 months (average:10.8 ± 3.9 months),no tumor recurrence or spinal deformation was found according to the imaging examination.CT examination showed that the split laminae tended to heal in the operative area.Conclusion The para-split laminotomy shows minimally invasive damage to the posterior spinal tension band and helps to protect the stability of the spine.It is feasible and effective to apply the para-split laminotomy in the operation of lumbar spinal canal tumors.