高位颈椎椎管内肿瘤术后早期神经功能恢复的影响

目的：考察高位颈椎椎管内肿瘤各病变指标与术后日本骨科学会（JOA）评分改善率之间的关系，探讨术后早期神经功能恢复的影响因素。方法回顾分析本院2008年4月—2014年10月收治并施行手术切除的52例高位颈椎椎管内肿瘤病例资料，记录临床表现、肿瘤位置与大小、手术前后美国脊髓损伤协会（ASIA）分级和JOA评分、并发症等信息，统计分析各因素与术后JOA评分改善率之间的关系。结果术前ASIA分级C级及以下的患者术后JOA评分改善率较低。相关性分析提示术后JOA评分改善率与肿瘤横断面定位和肿瘤长径之间存在线性相关，髓内肿瘤患者的JOA评分改善率较其余部位的低，肿瘤长径值越大，JOA评分改善率越低。年龄、病理征、肿瘤病理类型、术中出血量等与JOA评分改善率无明显相关性。并发症也影响JOA评分改善率，尤其髓内肿瘤术后出现的颈髓神经后遗症，严重影响术后神经功能。结论高位颈椎椎管内肿瘤术后神经功能恢复总体理想。但术前ASIA分级C级及以下、肿瘤较长、髓内肿瘤、术后出现并发症等因素可能提示术后早期神经功能恢复较差。

Influencing factors of neural function recovery after surgical treatment of upper cervical intraspinal canal tumor

Objective To investigate the relationship between the clinical parameters and postoperative Japanese Orthopaedic Association(JOA) score improvement rate in upper cervical intraspinal canal tumor patients,and explore the factors influencing neural function recovery. Methods Totally 52 patients with upper cervical intraspinal tumors underwent surgery from April 2008 to October 2014. The clinical data including clinical manifestations,tumor location,size,JOA score, American spinal injury association(ASIA) classification and complications were recorded,and the relationship between these factors and JOA score improvement rate was statistically analyzed. Results Patients with ASIA C and lower grade or the tumor with longer diameter had lower JOA improvement rate. Correlation analysis showed there were linear correlations between postoperative JOA improvement rate and both tumor position and the long diameter of the mass. There was no correlation between JOA improvement rate and age,pathologic signs,pathological type of the tumor,and bleeding. Complications,especially postoperative neurologic sequelae in intramedullary tumor,affect JOA improvement rate and lead to poor recovery of neural function. Conclusion Patients with upper cervical intraspinal tumors would achieve favorable recovery of neural function. However these factors including pre-operative ASIA C and lower grade,tumor with long diameter,intramedullary tumor and complications suggest an increased likelihood of worse neurofunctional recovery.