[Treatment of benign tumors in thoracic spinal canal by modified replanting posterior ligament complex applying piezoelectric osteotomy].

To investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal.The clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score.The operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value ( t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value ( t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%.Modified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.探讨应用超声骨刀行改良棘突椎板韧带复合体（posterior ligament complex，PLC）回植术治疗原发性胸椎管内良性肿瘤的可行性及疗效。.回顾分析 2014 年 3 月—2016 年 3 月收治并获完整随访的 38 例原发性胸椎管内良性肿瘤患者临床资料。其中男 16 例，女 22 例；年龄 21～72 岁，平均 47.1 岁。病程 6～57 个月，平均 32.6 个月。病理检查示神经鞘瘤 24 例、脊膜瘤 6 例、室管膜瘤 4 例、脂肪瘤 2 例、皮样囊肿 2 例。病变位于单节段 18 例，双节段 15 例，3 节段 5 例；肿物长度 0.7～6.5 cm，肿瘤与脊髓、马尾及神经根存在界限。术前日本骨科协会（JOA）评分为（12.2±2.3）分，胸椎 Cobb 角为（11.7±2.7）°。采用超声骨刀行改良 PLC 回植、显微镜下肿瘤切除术。术中保留一侧棘上、棘间韧带连续性，将 PLC 向侧方掀起显露，显微镜下摘除肿瘤后将带蒂 PLC 原位回植，双侧微型重建钛板固定。术后行 X 线片、CT 及 MRI 检查，观察脊柱稳定性、椎管成形及肿瘤切除情况，采用 JOA 评分进行临床效果评定。.手术时间为 56～142 min，平均 77.1 min；术中出血量为 110～370 mL，平均 217.2 mL。所有患者肿瘤完整切除，切口愈合良好。3 例出现脑脊液漏，无脊髓损伤、感染等相关并发症发生。38 例患者均获随访，随访时间 24～28 个月，平均 27.2 个月。随访期间无内固定物松动移位及其他相关并发症发生。末次随访时 X 线片复查未见脊柱侧后凸畸形及失稳征象；CT 复查椎板无移位及继发椎管容积减小，椎板均骨性愈合；MRI 示肿瘤无复发。末次随访时，胸椎 Cobb 角为（12.3±4.1）°，与术前比较差异无统计学意义（ t=0.753， P=0.456）；JOA 评分为（23.7±3.8）分，与术前比较差异有统计学意义（ t=15.960， P=0.000）；其中优 14 例、良 18 例、中 6 例，优良率 84.2%。.应用超声骨刀行改良 PLC 回植、微型重建钛板内固定术治疗原发性胸椎管内良性肿瘤，可恢复椎管正常解剖，操作安全，患者可早期活动，疗效较好。.