改良椎管扩大成形术和后路椎弓根螺钉固定术在腰椎椎管肿瘤手术中的比较
Comparison of the modified expanding suspended laminoplasty and posterior pedicle screw fixation for lumbar intraspinal tumors

摘要：目的 对比改良椎管扩大成形术和后路椎弓根螺钉固定术在腰椎椎管肿瘤手术中的应用，评价两种术式手术情况、并发症以及对于术后神经功能改善情况和腰椎稳定性的影响。 方法 回顾性分析114例腰椎椎管肿瘤患者的临床资料，其中66例行改良椎管扩大成形术，48例行后路椎弓根螺钉固定术，比较两组手术时间、出血量、术后脑脊液漏发生率。以及术后3、6、12、24月腰椎不稳发生率、JOA评分及JOA评分改善情况。结果 改良椎管扩大成形术患者手术时间、出血量、术后脑脊液漏发生率优于后路椎弓根螺钉固定术患者。两组间统计学有明显差异(P<0.01)。两组在术后腰椎不稳发生率比较无差别(P>0.05)。两组在术后3、6、12月JOA评分变化及JOA评分改善率方面无明显差异(P>0.05)。后路椎弓根螺钉固定组24月JOA评分变化及JOA评分改善率优于改良椎管扩大成形术组。结论 改良椎管扩大成形术和后路椎弓根螺钉固定术都有很好的术后腰椎稳定效果，术后脊髓神经功能恢复良好。远期神经脊髓功能改善方面后路椎弓根螺钉固定术优于改良椎管扩大成形术。
ABSTRACT: Objective To compare the modified expanding suspended laminoplasty and posterior pedicle screw fixation applied in lumbar intraspinal tumors and evaluate operation, complications, postoperative neurofunctional improvement and lumbar lumbar stability in the two groups. Methods We made a retrospective analysis of the clinical data of 114 cases of lumbar intraspinal tumors, including 66 cases of modified expanding suspended laminoplasty and 48 cases of posterior pedicle screw fixation. We compared the operation time, operation bleeding volume, and incidence of postoperative cerebrospinal fluid leakage in the two groups. We also analyzed the lumbar instability and spinal cord injury score standard by the Japanese Orthopedic Association (JOA) between the two groups at 3, 6, 12, and 24 months after operation. Results The results of modified expanding suspended laminoplasty group were significantly better than those of posterior pedicle screw fixation group in operation time, operation bleeding volume and incidence of postoperative cerebrospinal fluid leakage (P<0.01). The lumbar instability did not significantly differ between the two groups (P>0.05). At 3, 6 or 12 months after the operation, changes in the increase of JOA score of the two groups had no significant difference (P>0.05). However, 24 mouths after the operation, the group of posterior pedicle screw fixation had significantly improved JOA score compared with that in the modified expanding suspended laminoplasty group. Conclusion Both the modified expanding suspended laminoplasty and posterior pedicle screw fixation have a favorable outcome of postoperative lumbar instability and neurofunction. And posterior pedicle screw fixation is superior to modified expanding suspended laminoplasty in improving neurofunction