Kawahara N, Tomita K, Shinya Y, Matsumoto T, Baba H, Fujita T, Murakami H, Kobayashi T
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Japan.
Spine (Phila Pa 1976). 1999 Jul 1;24(13):1363-70. doi: 10.1097/00007632-199907010-00015.
A prospective study of patients whose spinal cord tumors were managed surgically with a unique posterior method of removing and replacing the posterior spinal elements using T-saw ("recapping T-saw laminoplasty").
To examine the safety and efficacy of the recapping T-saw laminoplasty technique for spinal canal surgery.
Laminectomy, laminoplasty, and/or laminotomy typically are used to approach intraspinal lesions. When removal and replacement of the posterior elements have been attempted, the effectiveness of the technique has been limited by the amount of bone sacrificed when using burrs or osteotomes. The authors thought to adapt a unique "threadwire saw" (T-saw) in these cases, because its use results in minimal bone loss.
Patients underwent recapping T-saw laminoplasty in the thoracic or lumbar spine for extirpation of spinal cord tumors. The T-saw was used for division of the posterior elements. After resection of the lesion, the excised laminae were replaced exactly in situ to their original anatomic position. The mean follow-up period was 47 months (range, 31-71 months). Patients were observed neurologically and radiologically.
One to eight laminae were excised and replaced in 24 patients. Findings on computed tomography scans confirmed primary bony union in 23 patients by 6 months after surgery, and in one patient by 12 months after surgery. No complications such as postoperative spinal canal stenosis, facet arthrosis, or kyphosis were observed.
Recapping laminoplasty afforded anatomic reconstruction of the vertebral arch after excision of spinal cord tumors. This procedure appears to warrant further evaluation as an alternative to wide laminectomies for exposure of intraspinal tumors.
一项对脊髓肿瘤患者进行的前瞻性研究，这些患者采用一种独特的后路方法，即使用T锯（“覆盖式T锯椎板成形术”）切除并替换后路脊柱结构进行手术治疗。
探讨覆盖式T锯椎板成形术在椎管手术中的安全性和有效性。
椎板切除术、椎板成形术和/或椎板切开术通常用于处理椎管内病变。当尝试切除并替换后路结构时，该技术的有效性受到使用磨钻或骨凿时牺牲骨量的限制。作者认为在这些病例中采用一种独特的“线锯”（T锯），因为其使用导致骨丢失最少。
患者在胸段或腰段脊柱接受覆盖式T锯椎板成形术以切除脊髓肿瘤。使用T锯分离后路结构。切除病变后，将切除的椎板精确原位替换到其原始解剖位置。平均随访期为47个月（范围31 - 71个月）。对患者进行神经学和影像学观察。
24例患者切除并替换了1至8个椎板。计算机断层扫描结果证实23例患者在术后6个月实现了原发性骨愈合，1例患者在术后12个月实现骨愈合。未观察到诸如术后椎管狭窄、小关节病或后凸畸形等并发症。
覆盖式椎板成形术在切除脊髓肿瘤后实现了椎弓的解剖重建。作为一种替代广泛椎板切除术以暴露椎管内肿瘤的方法，该手术似乎值得进一步评估。
