摘要
目的探讨进展型脊髓髓内海绵状血管畸形(ISC)的手术时机及其疗效。方法回顾性分析2013年1月至2018年1月复旦大学附属华山医院神经外科(21例)、复旦大学附属华山医院普陀分院(上海市普陀区人民医院)神经外科(3例)及复旦大学附属华东医院神经外科(3例)收治的27例进展型ISC患者的临床资料。根据手术时机将所有患者分为两组:一组首次急性发病至手术时间<3 d或反复发作后突然加重至手术时间<7 d[即急诊挽救性手术组(ESS),15例];另一组按常规时间手术(即非ESS组,12例)。术后对所有患者行临床随访,包括复查脊椎MRI以判断病变是否残留或复发;采用改良Aminoff-Logue量表评分(mALs)判断脊髓功能,其中较术前提高个等级为改善,不变为稳定,降低个等级为恶化。比较两组患者的临床疗效。采用单因素和多因素logistic回归法判断ESS是否为影响患者术后脊髓功能恢复的危险因素。结果27例患者的手术均成功,随访时间为(51.7±19.9)个月(12~80个月)。随访期间,所有患者的病变均无复发。至末次随访,17例患者的脊髓功能改善,10例患者的脊髓功能稳定。两组患者的性别、年龄、病程类型、病变累及脊髓节段、家族史、伴有颅内海绵状血管畸形或多发ISC、术前mALs、病变横径比及矢状径长度的差异均无统计学意义(均P>0.05);ESS组较非ESS组的发病至手术时间短[分别为(3.8±1.9)d、(10.7±4.7)d,P<0.05],且术后12个月脊髓功能改善的患者占比高(分别为13/15、4/12,P<0.05)。多因素logistic回归分析结果显示,ESS是术后脊髓功能恢复的保护性因素(OR=0.077,95%CI:0.011~0.521,P=0.009)。结论选择急诊挽救性手术可更好地改善进展型ISC患者的脊髓功能。且手术时机是影响进展型ISC患者术后脊髓功能的危险因素。
Objective To investigate the clinical efficacy and influencing factors of emergency salvage surgery(ESS)for progressive intramedullary spinal cavernomas(ISC).Methods A retrospective analysis was conducted on the clinical data of 27 patients with progressive ISC including 21 cases admitted to Department of Neurosurgery,Huashan Hospital,Fudan University,3 cases admitted to Department of Neurosurgery,Huashan Hospital Putuo branch-Shanghai Putuo District People's Hospital,and 3 cases admitted to Department of Neurosurgery,Huadong Hospital,Fudan university from January 2013 to January 2018.According to the timing of surgery,all patients were divided into two groups:emergency salvage surgery(ESS)group(15 cases)-the time from the first acute onset to surgery <3 d or the most resent onset to surgery <7 d;Non-ESS group(12 cases)-following the usual surgical schedule.All patients underwent clinical follow-up post operation,including reexamination of spinal MRI to determine whether the ISC remained or recurred and assessment of spinal function based on Aminoff-logue scale(mALs).Compared with pre-operation,an increase of ≥1 grade was regarded as improvement,no change as stable,and a decrease of ≥1 grade as deterioration.The clinical efficacy in the two groups was compared.Univariate and multivariate logistic regression analysis were applied to determine whether ESS was a key clinical factor affecting postoperative recovery of spinal cord function.Results The surgery was successfully performed in all 27 patients.The average duration of follow-up was 51.7±19.9 months(12-80 months).No ISC recurrence occurred in this series during follow-up.At the last follow-up,17 patients showed spinal cord function improvement and 10 were stable.There was no inter-group difference in the clinical factors including gender,age,type of clinical course,family history,segment of lesion,presence of intracranial cavernous malformation or multiple ISC,preoperative mALs score,transverse diameter ratio of lesion and sagittal diameter of lesion(all P>0.05).The onset to surgery in ESS group(3.8±1.9 d)was significantly shorter than that in non-ESS group(10.7±4.7 d)(P<0.05).ESS group had higher proportion of improvement of spinal cord function(13/15)than non-ESS group(4/12)(P<0.05).Multifactor logistic-regression analysis showed that ESS was an independent protecting factor of postoperative spinal cord function recovery(OR=0.077,95%CI:0.011-0.521,P=0.009).Conclusions ESS may improve spinal function in patients with deteriorated ISC and the time of surgery is a risk factor for postoperative spinal cord function recovery.Compared with conventional surgery,ESS could significantly improve spinal cord function of patients with progressive ISC,which is a positive factor for recovery of spinal cord function.
作者
陈功
秦宣锋
安庆祝
杨冰
曹浪
徐斌斌
李键
毛仁玲
段宇
Chen Gong;Qin Xuanfeng;An Qingzhu;Yang Bing;Cao Lang;Xu Binbin;Li Jian;Mao Renling;Duan Yu(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Marine Casualty Treatment,Naval Medical Center,Shanghai 200052,China;Department of Neurosurgery,the Third People’s Hospital of Jingdezhen,Jingdezhen 333000,China;Department of Neurosurgery,Huashan Hospital Putiw branch-Shanghai Putuo District People's Hospital,Shanghai 200060,China;Department of Neurosurgery,Huadong Hospital,Fudan University,Shanghai 200040,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第2期158-163,共6页
Chinese Journal of Neurosurgery
基金
上海市科委医学引导类支撑项目(18411962400)。
关键词
脊髓
血管瘤
海绵状
中枢神经系统
治疗结果
手术时机
Spinal cord
Hemangioma,cavernous,central nervous system
Treatment outcome
Timing of the operation
作者简介
通信作者:段宇,Email:duanyu926@163.com。
