Page 103 - 南京医科大学学报自然科学版

第41卷第7期 南京医科大学学报（自然科学版）
2021年7月 Journal of Nanjing Medical University（Natural Sciences） ·1033 ·

·临床医学·

椎管内肿瘤半椎板切除后骨片回纳对患者的影响

夏忠源，秦家骏，薛 飞，亢希鹏，陈先震 *

南京医科大学上海十院临床医学院，上海市第十人民医院神经外科，上海 200072

［摘 要］ 目的：研究椎管内肿瘤行半椎板切除术后骨片回纳对患者预后的影响，并构建患者预后的列线图预测模型。方法：
回顾性分析220例椎管内肿瘤行半椎板切除手术治疗的患者临床资料，椎板切除后骨片回纳者为研究组，骨片不回纳者为对
照组，比较两组手术时间、术中出血量、术后并发症、神经功能、脊柱稳定性等。采用广义相加模型对各结局变量与基线指标之
间的关系进行拟合，构建患者预后的预测模型。结果：术后1年，研究组脊髓神经功能和并发症改善率优于对照组（P=0.008，
P<0.001）。下颈段或单一节段半椎板切除后不回纳骨片者术中出血量小（P=0.027，P=0.001），胸段或2个节段椎板切除后骨片
回纳者出血量小（P=0.003，P < 0.001）。建立了术后1年McCormick评分＜3分、术后1年McCormick评分改善和术后1年脊柱
变形的预测模型，各模型特异度分别为 0.921、0.838、0.546，灵敏度分别为 0.526、0.576、0.906，准确度分别为 0.870、0.836、
0.798。结论：椎管内肿瘤行半椎板切除后回纳骨片有利于改善患者术后神经功能，减少术后并发症。从减少出血量角度考
虑，下颈段、单个节段半椎板切除建议不回纳骨片，而胸段、2个节段半椎板切除时建议回纳骨片。
［关键词］ 椎管内肿瘤；半椎板切除；回纳骨片；脊柱稳定性；预后；列线图
［中图分类号］ R651.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）07⁃1033⁃06
doi：10.7655/NYDXBNS20210715

The influence of lamina replantation after unilateral laminectomy for intraspinal tumors

XIA Zhongyuan，QIN Jiajun，XUE Fei，KANG Xipeng，CHEN Xianzhen *
Department of Neurosurgery，Clinical Medical College of Nanjing Medical University，Shanghai Tenth People’s
Hospital，Shanghai 200072，China

［Abstract］ Objective：To compare the effects of lamina replantation after unilateral laminectomy operational on the prognosis of
patients with intraspinal tumors，and to establish nomogram models for prediction of prognosis. Method：The clinical data of 220
patients with intraspinal tumors treated by unilateral laminectomy were collected and retrospectively analyzed. The patients were
divided into experimental group and control group according to whether the isolated bone was reset in situ or not. Operation time，
intraoperative blood loss，complications after operation，neurological function of spinal cord and spinal stability were compared.
Generalized additive model was used to establish prediction models for prognosis of patients by fitting the relationship between the
outcome variables and baseline indicators. Results：One year after operation，the improvement rate of spinal cord function and clinical
symptoms in the experimental group was better than those in the control group（P=0.008 and P < 0.001）. Patients receiving a lower
cervical laminectomy or a single segment laminectomy suffered more blood loss if conducting a lamina reposition（P=0.027 and P=
0.001），while patients underwent a thoracic laminectomy or double segments laminectomy showed less blood loss when a lamina
reposition conducted（P=0.003 and P < 0.001）. The prediction models of McCormick score < 3，improvement of McCormick score，and
spinal deformation in one year after operation were established. The specificity，sensitivity and accuracy of the models were 0.921，
0.838 and 0.546，0.526，0.576 and 0.906，0.870，0.836 and 0.798，respectively. Conclusion：Lamina reposition after unilateral
laminectomy for intraspinal tumors helps to improve spinal cord function and reduce complications. Lamina reposition is not
recommended when operational exposure happens on a single segment vertebra or in the lower cervical lamina，but recommended when
unilateral laminectomy happens on two segments vertebra or cervical vertebra.
［Key words］ intraspinal tumor；unilateral laminectomy；lamina replantation；spinal stability；prognosis；nomogram
［J Nanjing Med Univ，2021，41（07）：1033⁃1038］
［基金项目］ 上海市卫生健康委员会面上项目（201940126）
∗
通信作者（Corresponding author），E⁃mail：chenxianzheny@126.com