接触式激光刀在脂肪瘤型脊髓栓系中的临床应用  

Clinical application of contact lasers in the lipomyoma type of tethered cord syndrome

作　　者：王振刚 周立兵 娄红民 魏发伟 朱伟杰 Zhengang Wang;Libing Zhou;Hongmin Lou;Fawei Wei;Weijie Zhu(Department of Neurosurgery,the 960th Hospital of PLA Joint Logistic Support Force,Ji'nan 250031,China;Department of Neurosurgery,Leling People's Hospital,Dezhou 253600,China;Department of Neurosurgery,Heze Sixth People's Hospital,Heze 274000,China;Department of Neurosurgery,Lingcheng People's Hospital,Dezhou 253500,China)

机构地区：[1]解放军联勤保障部队第九六〇医院神经外科,济南250031 [2]乐陵市人民医院神经外科,山东德州253600 [3]菏泽市第六人民医院神经外科,山东菏泽274000 [4]德州市陵城区人民医院神经外科,山东德州253500

出　　处：《中华神经创伤外科电子杂志》2024年第6期345-350,共6页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：第42期中日笹川医学奖学金(K20204227)

摘　　要：目的评价接触式激光刀在脂肪瘤型脊髓栓系中的应用疗效。方法回顾性分析自2021年4月至2023年6月由同一术者主刀实施手术的28例脂肪瘤型脊髓栓系患者的临床资料。所有患者均在电生理神经功能监测、显微镜或3D外视镜下使用接触式激光刀手术。采用Kirollos和Van-Hille分级评估术中栓系松解程度,采用JOA评分评估患者的神经功能。结果接触式激光刀使用过程中术野出血量少,平均65 mL,术后未出现感染、死亡病例,术毕均无不可逆性电生理监测报警。28例患者中,25例(89.29%)患者脊髓得到彻底松解,2例(7.14%)患者部分松解,1例(3.57%)患者无法松解。28例患者术后JOA分数较术前均有不同程度地改善,以10~15分、16~24分的人数变化尤为明显。随访3~24个月,无新增严重神经功能障碍病例。结论应用接触式激光刀进行脂肪瘤型脊髓栓系手术,能精准高效地切除脂肪瘤样组织尤其是混杂韧性纤维的组织,可减少术中失血及热损伤,有利于提高脊髓栓系松解率,提高脂肪瘤型脊髓栓系手术疗效。Objective To evaluate the effects of contact lasers in the lipomyoma type of tethered cord syndrome(TCS).Methods A retrospective analysis was conducted on the clinical data of 28 patients with lipomyoma type of TCS who were operated solely by one surgeon from April 2021 to June 2023.All patients received contact lasers assisted by electrophysiological monitoring,microscope and three-dimensional external view mirror.Kirollos and Van Hille grading were used to evaluate the degree of loosening of the thrombus during surgery;JOA score was used to assess the neurological function of patients before and after surgery.Results During the use of the contact laser,the amount of bleeding in the surgical field was minimal,with an average of 65 mL.There were no cases of infection or death after surgery,and there were no irreversible electrophysiological monitoring alarms at the end of the operation.Among 28 patients,25(89.29%)had complete release of the spinal cord,2(7.14%)had partial release,and 1(3.57%)had no release.Twenty-eight patients showed varying degrees of improvement in postoperative JOA scores compared to preoperative levels,with particularly significant changes observed in the number of patients scoring 10-15 and 16-24.Follow up for 3-24 months showed no new cases of severe neurological dysfunction.Conclusion Contact lasers could accurately remove lipomatoid tissue especially mixed tough fibre for the lipomyoma type of TCS,little bleeding and low thermal damage,in favour of increasing the proportion of releasing degree,increasing the curative effect for the lipomyoma type of TCS.

关 键 词：脊髓栓系综合征 脂肪瘤 接触式激光刀 电生理监测 

分 类 号：R651.2[医药卫生—外科学]