旁正中椎板撑开复位术治疗腰椎肿瘤的疗效及中期随访分析  

Clinical effects and mid-term follow-up analysis of para-split laminotomy for lumbar spinal canal tumors

作　　者：彭浩 张恒柱 王晓东 严正村 汤灿 王杏东 魏民 佘磊 Peng Hao;Zhang Hengzhu;Wang Xiaodong;Yan Zhengcun;Tang Can;Wang Xingdong;Wei Min;She Lei(Department of Neurosurgery,Clinical Medical College,Yangzhou University,Yangzhou 225000,China)

机构地区：[1]扬州大学临床医学院神经外科,扬州225000

出　　处：《国际外科学杂志》2023年第4期259-264,共6页International Journal of Surgery

基　　金：江苏省第五期333工程科研项目(BRA2019026)。

摘　　要：目的探讨旁正中椎板撑开复位术对腰椎管肿瘤的治疗效果及预后相关因素。方法回顾性分析2016年10月-2019年8月扬州大学临床医学院神经外科采用旁正中椎板撑开复位术治疗的35例腰椎管肿瘤患者的临床资料,男性16例,女性19例,年龄(40.1±10.6)岁。观察术中出血量、手术时间、肿瘤切除情况、肿瘤病理结果、围手术期并发症等。采用门诊和电话方式进行随访,评估肿瘤复发、椎板愈合及脊柱稳定性情况,时间截至2022年8月。以日本骨科协会(JOA)下腰痛评分系统对患者脊髓神经功能状态评分,比较患者术前和术后的总体评分,单因素分析筛选影响预后的因素并进行多元线性回归分析。正态分布的计量资料以均数±标准差(x±s)表示,手术前后比较采用配对t检验。偏态分布的计量资料以M(Q_(1),Q_(3))表示。计数资料以例数表示。结果35例患者肿瘤均完全切除,手术出血量为100(75,140)mL,手术时间为(181.1±42.7)min,术后病理诊断为神经鞘瘤24例、脊膜瘤6例、室管膜瘤4例、神经纤维瘤1例。未发生手术相关并发症。术后随访36~69个月,影像学检查所有患者肿瘤无复发,无脊柱失稳,部分患者可见椎板骨性愈合。患者手术前后脊髓神经功能总体评分分别为(19.5±3.4)分、(25.4±2.2)分,配对t检验分析得出术后比术前有显著性改善,两者相比差异具有统计学意义(P<0.05)。单因素分析显示,年龄、肿瘤体积、切开节段数、术前JOA评分、术中出血量与术后JOA评分有关(P<0.05);多元线性回归分析结果中术前JOA评分与术后JOA评分呈明显正相关,肿瘤体积、患者年龄与术后JOA评分呈明显负相关(P<0.05)。结论旁正中椎板撑开复位术对脊柱后方结构损伤小,可有效改善腰椎管肿瘤患者脊髓神经功能状态和保护腰椎稳定性,且术前脊髓神经功能状态越好,患者预后越好,肿瘤体积越小,预后越好。Objective To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors,who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery,Clinical Medical College of Yangzhou University from October 2016 to August 2019,including 16 males and 19 females,and the age was(40.1±10.6)years.Intraoperative blood loss,operation time,tumor resection,tumor pathological results,perioperative complications were observed.Follow-up situations,including tumor recurrence,bony fusion of laminae and spinal stability.Follow-up using outpatient examination and telephone interview was performed by the end of August 2022.The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord,and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores.Linear regression and multiple linear regression were used to analyze the prognostic factors.Measurement data of normal distribution were expressed as mean±standard deviation(x±s),and the comparison before and after operation was performed by paired t-test.Mearsurement data of skewed distribution were expressed as M(Q_(1),Q_(3)).Count data were expressed as cases.Results The tumors of 35 patients were resected completely.The median blood loss was 100(75,140)mL and the average operative duration was(181.1±42.7)min.The postoperative pathological results were as follows:24 neurilemmomas,6 meningiomas,4 ependymomas and 1 neurofibroma.There were no surgery-related complications occurred.The postoperative follow-up ranged from 36 to 69 months,with no tumor recurrence or spinal instability,and bony fusion of laminae seen in some patients on CT imaging.The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2),Paired t-test analysis revealed a significant differe

关 键 词：腰椎 预后 随访研究 旁正中椎板撑开 腰椎管肿瘤 

分 类 号：R738.1[医药卫生—肿瘤]