论文部分内容阅读
[目的]总结椎管内髓外肿瘤诊疗方法并分析其影响预后的相关因素。[方法]回顾性分析手术治疗168例椎管内髓外肿瘤患者,分析其影像学特点,并通过JOA评分评价临床疗效。评价患者病程、年龄、术前JOA评分与临床效果之间的关系。[结果]患者平均42岁(7～73岁),平均病程18.6个月(2～28个月)。肿瘤位于颈段者45例(28.7%),胸段者62例(39.5%),腰骶段者61例(38.9%),以神经鞘瘤和脊膜瘤为主,分别占53.6%、22.6%。随访时间为13～52个月,平均29.8个月,肿瘤完全切除160例(95.2%),部分切除8例(4.8%)。JOA评分:术前5～12分,平均7.6分,术后8～16分,平均13.8分,改善率为66.0%。依据Epstein标准:优150例,良10例,改善8例。患者病程、年龄与临床改善率呈负相关,相关系数分别为-0.353、-0.521,术前JOA评分与临床改善率呈正相关,相关系数为0.413。[结论]椎管内肿瘤临床疗效与病程、年龄、术前症状存在显著相关性。详细的病史采集、体检和影像学MRI检查是关键的诊疗手段。
[Objective] To summarize the methods of diagnosis and treatment of intramedullary extramedullary tumors and analyze the related factors that affect prognosis. [Methods] A retrospective analysis of 168 patients with intramedullary extramedullary tumors surgery, analysis of imaging features, and by JOA score evaluation of clinical efficacy. Evaluation of the patient’s duration, age, preoperative JOA score and the relationship between clinical effects. [Results] The average patient was 42 years (range, 7 to 73 years) with an average duration of 18.6 months (range 2 to 28 months). Forty-five patients (28.7%) were in the cervical segment, 62 (39.5%) were in the thoracic segment, and 61 (38.9%) were in the lumbosacral segment. The majority were schwanoma and meningioma, accounting for 53.6% and 22.6% respectively %. The follow-up time ranged from 13 to 52 months with an average of 29.8 months. Tumors were completely resected in 160 cases (95.2%) and partially resected in 8 cases (4.8%). JOA score: 5 to 12 points before surgery, an average of 7.6 points, 8 to 16 points after surgery, an average of 13.8 points, an improvement rate of 66.0%. According to Epstein criteria: excellent in 150 cases, good in 10 cases, improved in 8 cases. The course of disease, age and clinical improvement rate were negatively correlated, the correlation coefficients were -0.353, -0.521, preoperative JOA score and clinical improvement rate was positively correlated with a correlation coefficient of 0.413. [Conclusion] The clinical curative effect of spinal canal tumor has significant correlation with the course of disease, the age and preoperative symptoms. Detailed history collection, physical examination and imaging MRI examination is the key diagnosis and treatment.