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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摘要
目的探讨超声骨刀在椎管内肿瘤切除后椎管成形术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(T_(10)1例、T_(12) 3例),腰椎管内肿瘤13例(L_1 5例、L_2 4例、L_3 2例、L_4 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 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors(T_(10) in 1, T_(12) in 3) and 13 cases of lumbar intrathoracic tumors(L_1 in 5, L_2 in 4, L_3 in 2, and L_4 in 2).Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were 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 threedimensional 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,nerve root injury, or 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 threedimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was 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 effectiveness.
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 42-73 years with an average of 57.4 years. The disease duration was 2-47 months with an average of 21.1 months. Among them, there were 4 cases of thoracic intrathoracic tumors(T_(10) in 1, T_(12) in 3) and 13 cases of lumbar intrathoracic tumors(L_1 in 5, L_2 in 4, L_3 in 2, and L_4 in 2).Postoperative pathological diagnosis showed that 8 cases were schwannoma, 4 cases were meningioma, 2 cases were neurofibroma, 2 cases were 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 threedimensional 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,nerve root injury, or 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 threedimensional reconstruction showed good bone healing in all patients. During the follow-up, there was no loosening or rupture of the internal fixator and there was 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 effectiveness.
引文
1王贵怀.椎管内肿瘤.中国现代神经疾病杂志, 2013, 13(12):983-985.
2Al-Mahfoudh R, Qattan E, Ellenbogen JR, et al. Applications of the ultrasonic bone cutter in spinal surgery—our preliminary experience. Br J Neurosurg, 2014, 28(1):56-60.
3陈旭锋,陈铁,赖仁发.超声骨刀在种植外科中的应用进展.中华老年口腔医学杂志, 2015, 13(1):44-46.
4唐德争,谭包生,郭德惠.上颌窦侧壁开窗提升术术后5年以上的临床病例分析.口腔颌面修复学杂志, 2013, 14(2):78-83.
5Grauvogel J, Scheiwe C, Kaminsky J. Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy. Spine J, 2014, 14(4):628-636.
6Bydon M, Macki M, Xu R, et al. Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette:technical note and outcomes in 30 cases. J Pediatr Orthop, 2014, 34(8):780-786.
7王岩,陈仲强,孙垂国.超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性.中国脊柱脊髓杂志, 2015, 25(6):518-523.
8陈萧霖,郑小青,陈仲强,等.系统评价超声骨刀在脊柱手术中应用的有效性与安全性.中国脊柱脊髓杂志, 2016, 26(10):899-903.
9杨鹏,温冰涛,金开基,等.应用超声骨刀行腰椎后路椎板切除术与传统手术技术的对比研究.中国脊柱脊髓杂志, 2017, 27(8):699-703.
10李文菁,赵宇,孙志坚.超声骨刀在脊柱外科手术中的应用进展.中华外科杂志, 2014, 52(3):215-218.
11王齐超,王海蛟,何兵,等.超声骨刀在颈椎椎板(C3~7)单开门椎管扩大成形术中的应用.中国骨与关节损伤杂志, 2016, 31(11):1121-1123.
12陈佳佳,崔志明.微创内镜下手术治疗退变性腰椎管狭窄症的研究进展.中华临床医师杂志(电子版), 2017, 11(3):458-461.
13 Radcliff K, Curry P, Hilibrand A, et al. Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis:a subgroup analysis of the Spine Patient Outcomes Research Trial(SPORT). Spine(Phila Pa 1976), 2013, 38(7):531-539.
14Raimondi AJ, Gutierrez FA, Di Rocco C. Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J Neurosurg, 1976, 45(5):555-560.
15刘盛泽,林健,陈实.椎管内肿瘤的手术治疗体会及疗效观察.中华神经外科杂志, 2014, 30(8):824-827.
16Yang L, Gu Y, Shi J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics, 2013, 36(1):e79-e87.
17丁超,孙海燕,王英胜,等.超声骨刀在脊柱椎板回植术中的应用.颈腰痛杂志, 2015, 36(2):140-143.
18Horton JE, Tarpley TM Jr, Wood LD. The healing of surgical defects in alveolar bone produced with ultrasonic instrumentation,chisel, and rotary bur. Oral Surg Oral Med Oral Pathol, 1975,39(4):536-546.
19 薛旭凯,李高飞,江建明.超声骨刀与高速磨钻在颈后路单开门椎管扩大成形术中的应用对比.中国骨科临床与基础研究杂志,2016, 8(2):75-80.
20Schaller BJ, Gruber R, Merten HA, et al. Piezoelectric bone surgery:a revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note Neurosurgery, 2005, 57(4Suppl):E410.
21Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery:experience from the first 128patients. Eur Spine J, 2013, 22(12):2845-2849.
22田德洲,张远征,董永军,等.“高架桥式”椎管扩大成型术治疗颈椎管狭窄脊髓压迫症.中华神经外科疾病研究杂志, 2015,14(6):531-534.
23 周冲,杨福兵,王斌,等.超声骨刀在椎管内肿瘤切除术中的应用.第三军医大学学报, 2016, 38(2):200-203.
2Al-Mahfoudh R, Qattan E, Ellenbogen JR, et al. Applications of the ultrasonic bone cutter in spinal surgery—our preliminary experience. Br J Neurosurg, 2014, 28(1):56-60.
3陈旭锋,陈铁,赖仁发.超声骨刀在种植外科中的应用进展.中华老年口腔医学杂志, 2015, 13(1):44-46.
4唐德争,谭包生,郭德惠.上颌窦侧壁开窗提升术术后5年以上的临床病例分析.口腔颌面修复学杂志, 2013, 14(2):78-83.
5Grauvogel J, Scheiwe C, Kaminsky J. Use of Piezosurgery for removal of retrovertebral body osteophytes in anterior cervical discectomy. Spine J, 2014, 14(4):628-636.
6Bydon M, Macki M, Xu R, et al. Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette:technical note and outcomes in 30 cases. J Pediatr Orthop, 2014, 34(8):780-786.
7王岩,陈仲强,孙垂国.超声骨刀在胸椎管狭窄症手术中应用的有效性与安全性.中国脊柱脊髓杂志, 2015, 25(6):518-523.
8陈萧霖,郑小青,陈仲强,等.系统评价超声骨刀在脊柱手术中应用的有效性与安全性.中国脊柱脊髓杂志, 2016, 26(10):899-903.
9杨鹏,温冰涛,金开基,等.应用超声骨刀行腰椎后路椎板切除术与传统手术技术的对比研究.中国脊柱脊髓杂志, 2017, 27(8):699-703.
10李文菁,赵宇,孙志坚.超声骨刀在脊柱外科手术中的应用进展.中华外科杂志, 2014, 52(3):215-218.
11王齐超,王海蛟,何兵,等.超声骨刀在颈椎椎板(C3~7)单开门椎管扩大成形术中的应用.中国骨与关节损伤杂志, 2016, 31(11):1121-1123.
12陈佳佳,崔志明.微创内镜下手术治疗退变性腰椎管狭窄症的研究进展.中华临床医师杂志(电子版), 2017, 11(3):458-461.
13 Radcliff K, Curry P, Hilibrand A, et al. Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis:a subgroup analysis of the Spine Patient Outcomes Research Trial(SPORT). Spine(Phila Pa 1976), 2013, 38(7):531-539.
14Raimondi AJ, Gutierrez FA, Di Rocco C. Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J Neurosurg, 1976, 45(5):555-560.
15刘盛泽,林健,陈实.椎管内肿瘤的手术治疗体会及疗效观察.中华神经外科杂志, 2014, 30(8):824-827.
16Yang L, Gu Y, Shi J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics, 2013, 36(1):e79-e87.
17丁超,孙海燕,王英胜,等.超声骨刀在脊柱椎板回植术中的应用.颈腰痛杂志, 2015, 36(2):140-143.
18Horton JE, Tarpley TM Jr, Wood LD. The healing of surgical defects in alveolar bone produced with ultrasonic instrumentation,chisel, and rotary bur. Oral Surg Oral Med Oral Pathol, 1975,39(4):536-546.
19 薛旭凯,李高飞,江建明.超声骨刀与高速磨钻在颈后路单开门椎管扩大成形术中的应用对比.中国骨科临床与基础研究杂志,2016, 8(2):75-80.
20Schaller BJ, Gruber R, Merten HA, et al. Piezoelectric bone surgery:a revolutionary technique for minimally invasive surgery in cranial base and spinal surgery? Technical note Neurosurgery, 2005, 57(4Suppl):E410.
21Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery:experience from the first 128patients. Eur Spine J, 2013, 22(12):2845-2849.
22田德洲,张远征,董永军,等.“高架桥式”椎管扩大成型术治疗颈椎管狭窄脊髓压迫症.中华神经外科疾病研究杂志, 2015,14(6):531-534.
23 周冲,杨福兵,王斌,等.超声骨刀在椎管内肿瘤切除术中的应用.第三军医大学学报, 2016, 38(2):200-203.