ARCH 板固定开门椎板成形术在颈椎椎管内肿瘤中的应用。
Application of open-door laminoplasty with ARCH plate fixation in cervical intraspinal tumors.
机构信息
Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China.
Department of Operating Room, Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
出版信息
BMC Surg. 2021 Mar 19;21(1):141. doi: 10.1186/s12893-021-01140-3.
BACKGROUND
The open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors.
METHODS
This was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test.
RESULTS
A total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P < 0.01). The JOA score was improved from 9.9 ± 1.5 to 15.5 ± 0.6 (t = - 18.36, P < 0.01), and the mean JOA recovery rate was 79% ± 11% at 24 months after the operation. There was no significant difference in Cobb angle between pre-operation and 24 months after the operation, which was 9.8 ± 2.6 and 10.3 ± 3.1 respectively (t = - 0.61, P > 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up.
CONCLUSIONS
Open-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors.
背景
对于治疗颈椎脊髓病，开门式椎板成形术是一种有效的方法。然而，关于治疗椎管内肿瘤的开门式椎板成形术的手术结果，信息很少。在本研究中，我们旨在研究 ARCH 板固定的开门式椎板成形术治疗颈椎椎管内肿瘤的临床效果。
方法
这是一项回顾性研究。2013 年 1 月至 2018 年 5 月，我院收治 38 例颈椎椎管内肿瘤患者（男 13 例，女 25 例，平均年龄 44±17 岁），采用 ARCH 板固定行开门式椎板成形术。测定手术时间、出血量、术前和术后视觉模拟量表（VAS）和日本骨科协会（JOA）评分。为了确定影像学结果，在术前和术后均进行颈椎 X 线片和磁共振成像（MRI）检查，并使用颈椎 X 线侧位片测量 Cobb 角。采用 t 检验比较手术前后的临床资料。
结果
38 例患者均顺利完成手术，切口一期愈合。平均手术时间为 113±12min，平均出血量为 120±19mL。所有患者均获得随访，随访时间为 26.1±2.8 个月，随访时间均超过 24 个月。术后 24 个月 VAS 评分明显优于术前，从 6.1±1.1 分降至 1.4±0.7 分（t=32.63，P<0.01）。JOA 评分从术前的 9.9±1.5 分提高到术后 24 个月的 15.5±0.6 分（t=-18.36，P<0.01），术后 24 个月的平均 JOA 恢复率为 79%±11%。术后颈椎 X 线和 MRI 检查未见冠状面脊柱失稳或椎板成形瓣移位，术后 24 个月 Cobb 角与术前比较差异无统计学意义，分别为 9.8±2.6°和 10.3±3.1°（t=-0.61，P>0.05）。
结论
ARCH 板固定的开门式椎板成形术是治疗颈椎椎管内肿瘤的一种安全有效的手术方法。
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