进行性脊髓外受压脊髓损伤加重的因素分析

发布时间：2018-04-26 05:04

本文选题：椎管内肿瘤 + 脊髓损伤　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1.探讨分析进行性脊髓髓外受压脊髓损伤以及脊髓损伤加重的危险因素;2.分析激素在脊髓受压脊髓损伤手术患者中的应用价值;3.为临床上椎管内脊髓压迫性病变患者的治疗和神经功能恢复提供参考。[方法]病例资料:收集我科2014年6月-2017年2月期间收治的椎管内脊髓压迫性病变患者手术前和手术后的临床资料。根据研究设计标准,纳入研究的患者有229例。所有患者均采取后正中入路全椎板切除病变摘除脊髓减压术,术闭椎板还纳椎管重塑。手术均由我科椎管内病变手术熟练的副主任医师职称以上的医师和同时具有副主任医师职称以上的麻醉医师完成。229例患者在随访结束前均未进行康复治疗。根据可能影响SCI的因素包括:年龄、性别、脊髓受压程度是否大于椎管内直径的1/2、术中激素使用、肿瘤与脊髓的相对位置和肿瘤的侵袭性等分别进行单因素分析。单因素分析显著性变化的进入非条件性多因素logistic回归模型进行多元性分析,P0.05为差异有统计学意义。多因素logistic回归模型进行多元性分析显示:脊髓受压程度是否大于椎管内直径的1/2、年龄、脊髓受压迫所在位置和阶段以及肿瘤的侵袭性为相对独立危险因素,并对SCI加重者术前和术后JOA评分变化以及激素使用研究组的不同时期JOA评分变化进行组内分析对比研究。数据统计学处理:所有数据均采用SPSS 22.0统计软件进行分析。运用JOA评分进行术前和术后SCI神经功能变化进行评估。[结果]对229例患者进行住院治疗评估和随访分析,术后发生SCI加重者为32例,发生率13.97%;根据JOA评分标准,32例SCI加重患者术前JOA评分为14.6±1.8,术后1个月末次随访JOA评分12.2±1.2,统计学分析,P0.05,具有统计学意义。单因素分析性别、放置引流因素和病变节段等,P0.05,差异无统计学意义;高龄、脊髓受压程度、肿瘤是否位于脊髓腹侧等因素,P0.05,差异有统计学意义。多因素logistic回归模型进行多元性分析:高龄、脊髓受压严重、病变位于腹侧和病变具有侵袭性是SCI术后加重的危险因素差异具有统计学意义(P0.05)。激素使用研究组的不同时期JOA评分变化进行组内分析,(P0.05),差异具有统计学意义。[结论]1.在进行性脊髓外压迫性疾病中当压迫超过椎管内直径的1/2时,术前和术后显示脊髓损伤严重,神经功能的恢复差且时间较长,证实了早期治疗的价值;2.合理的使用激素对于脊髓外压迫解除后脊髓功能的恢复非常重要,尤其对于病变体积大、脊髓受压严重和病变位于腹侧及腹外侧者;3.脊髓外压迫性病变性质、所在的节段和位置的不同,术后脊髓损伤加重不同;4.椎管内脊髓病变手术需严谨、轻柔、精确的手术操作技巧和经验,尤其在切除腹侧和具有侵袭性的肿瘤时对脊髓保护、降低手术操作副损伤的重要性。
[Abstract]:[objective] 1. Objective to investigate the risk factors of progressive spinal cord compression injury and exacerbation of spinal cord injury. To analyze the application value of hormone in patients with spinal cord compression injury. To provide a reference for the treatment and recovery of neurologic function in patients with spinal cord compression lesion. [methods] case data: the clinical data of patients with spinal cord compression lesions treated in our department from June 2014 to February 2017 were collected before and after operation. According to the study design criteria, 229 patients were included in the study. All patients were treated with posterior median approach total laminectomy and spinal cord decompression. All the operations were performed by the doctors who were skilled in the operation of intraspinal diseases and the anesthesiologists who also had the titles of deputy chief physicians. All the 229 patients were not treated with rehabilitation before the end of follow-up. Univariate analysis was carried out according to the factors that might influence SCI, such as age, sex, degree of spinal cord compression greater than 1 / 2 of spinal canal diameter, intraoperative hormone use, relative position of tumor to spinal cord and tumor invasiveness. Univariate analysis of significant changes into the non-conditional multivariate logistic regression model for diversity analysis was statistically significant. The multivariate logistic regression model showed that the degree of spinal cord compression was greater than 1 / 2 of the spinal canal diameter, the age, the location and stage of spinal cord compression and the invasiveness of the tumor were relatively independent risk factors. The changes of JOA score before and after SCI exacerbation and the changes of JOA score at different stages in hormone use study group were analyzed and compared. Data statistics processing: all data were analyzed by SPSS 22. 0 statistical software. The changes of SCI nerve function were evaluated by JOA score before and after operation. [results] SCI exacerbation occurred in 32 cases after operation, and was evaluated and followed up in 229 cases. According to the JOA score, the preoperative JOA score was 14.6 卤1.8 in 32 patients with SCI aggravation, and the JOA score was 12.2 卤1.2 at the end of one month after operation, which was statistically significant (P 0.05). In univariate analysis, there was no significant difference in sex, placement of drainage factors and pathological segment (P0.05), but there was no significant difference in the elderly, spinal cord compression degree, tumor located in ventral side of spinal cord and so on (P0.05). Multivariate logistic regression model was used to analyze the multiple factors: the elderly, the severe compression of spinal cord, the location of the lesion in the ventral side and the invasiveness of the lesion were the risk factors of the aggravation after SCI. There was significant difference in the risk factors after SCI operation (P 0.05). The changes of JOA score in the study group were analyzed in group A (P 0.05 0. 05), and the difference was statistically significant. [conclusion] 1. In progressive extraspinal compression disease, when compression was more than 1 / 2 of the intraspinal diameter, the spinal cord injury was serious before and after operation, the recovery of nerve function was poor and the time was long, which confirmed the value of early treatment. Rational use of hormones is very important for the recovery of spinal cord function after decompression, especially for those with large size, severe compression of spinal cord and ventral and ventrolateral lesions. The spinal cord injury was aggravated by different levels and positions of the extracorporeal compression lesion. 4. The surgical techniques and experience of intraspinal spinal cord disease should be rigorous, gentle and precise, especially in the treatment of ventral and aggressive tumors, and the importance of surgical collateral injury should be reduced.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.2

【参考文献】