颈髓髓内肿瘤的手术治疗及预后因素分析

目的 探讨颈髓髓内肿瘤手术治疗及患者术后神经功能状况的预后因素。方法 回顾性分析2009年1月至2013年12月间接受手术治疗的65例颈髓髓内肿瘤患者资料。应用McCormick分级系统评估患者手术前后神经功能状态,并采用多因素logistic回归法分析术后神经功能状况的预后因素。结果 术中采用全椎板切除暴露61例,单侧多节段椎板间开窗(Unilateral Multilevel Interlaminar Fenestration, UMIF)4例。肿瘤全切48例,次全切除4例,部分切除13例。术后临床症状好转42例,维持术前14例,加重9例。其中疼痛缓解率最高(82.4%),其次为括约肌功能障碍(68.8%),感觉障碍缓解率最低(39.6%)。根据McCormick评分标准,术后神经功能好转18例(27.7%),维持术前水平39例(60%),8例(12.3%)患者神经功能恶化。多因素logistic回归分析提示良好的术前神经功能状态(OR=19.87,95% CI=4.10-96.23,P=0.000)和手术全切(OR=7.40,95% CI=1.34-40.95,P=0.022)是术后神经功能状况的保护因素。结论 显微手术切除是颈髓髓内肿瘤的首选治疗方式,术后患者大都预后良好。术前神经功能状态及手术切除范围与患者神经功能预后相关。

Surgical treatment and prognostic factors of cervical intramedullary spinal cord tumors

Objective To summarize experiences in surgical treatment of cervical intramedullary spinal cord tumors and identify prognostic factors associated with postoperative neurological status. Methods The clinical data of 65 consecutive patients underwent operation for cervical intramedullary spinal cord tumors between Jan.2009 and Dec.2013 were retrospectively reviewed. McCormick Scale was applied to evaluate preoperative and postoperative neurological functions. Multivariate logistic regression analysis was used to determine the independent prognostic factors of postoperative neurological status. Results Of all 65 patients, 48 received total resection, 4 subtotal resection and 13 partial resection. Laminectomy was performed in 61 patients and unilateral multilevel interlaminar fenestration (UMIF) was applied in 4 patients. Clinical syndromes relieved in 42 patients after operation, became stable in 14 and worse in 9. Among them, pain had the highest remission rate of 82.4%, followed by sphincter dysfunction (68.8%), and sensory disturbance had the lowest recovery rate (39.6%). Based on McCormick Scale, postoperative neurological functions improved in 18 patients (27.7%) and became stable in 39 patients (60%). Eight patients (12.3%) developed neurological deterioration. Multivariate logistic regression analysis revealed that good preoperative neurological function (OR=19.87, 95% CI=4.10-96.23, P=0.000)and total resection (OR=7.40, 95% CI=1.34-40.95, P=0.022) were independent protective factors for postoperative neurological status. Conclusion Microsurgical resection is the first-line treatment for cervical intramedullary spinal cord tumors, which can achieve a satisfying outcome in most cases. Preoperative neurological status and surgical extent were significantly associated with postoperative functional outcome.