本文選題：椎管內(nèi)腫瘤 + 脊髓損傷�。� 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]1.探討分析進行性脊髓髓外受壓脊髓損傷以及脊髓損傷加重的危險因素;2.分析激素在脊髓受壓脊髓損傷手術(shù)患者中的應用價值;3.為臨床上椎管內(nèi)脊髓壓迫性病變患者的治療和神經(jīng)功能恢復提供參考。[方法]病例資料:收集我科2014年6月-2017年2月期間收治的椎管內(nèi)脊髓壓迫性病變患者手術(shù)前和手術(shù)后的臨床資料。根據(jù)研究設計標準,納入研究的患者有229例。所有患者均采取后正中入路全椎板切除病變摘除脊髓減壓術(shù),術(shù)閉椎板還納椎管重塑。手術(shù)均由我科椎管內(nèi)病變手術(shù)熟練的副主任醫(yī)師職稱以上的醫(yī)師和同時具有副主任醫(yī)師職稱以上的麻醉醫(yī)師完成。229例患者在隨訪結(jié)束前均未進行康復治療。根據(jù)可能影響SCI的因素包括:年齡、性別、脊髓受壓程度是否大于椎管內(nèi)直徑的1/2、術(shù)中激素使用、腫瘤與脊髓的相對位置和腫瘤的侵襲性等分別進行單因素分析。單因素分析顯著性變化的進入非條件性多因素logistic回歸模型進行多元性分析,P0.05為差異有統(tǒng)計學意義。多因素logistic回歸模型進行多元性分析顯示:脊髓受壓程度是否大于椎管內(nèi)直徑的1/2、年齡、脊髓受壓迫所在位置和階段以及腫瘤的侵襲性為相對獨立危險因素,并對SCI加重者術(shù)前和術(shù)后JOA評分變化以及激素使用研究組的不同時期JOA評分變化進行組內(nèi)分析對比研究。數(shù)據(jù)統(tǒng)計學處理:所有數(shù)據(jù)均采用SPSS 22.0統(tǒng)計軟件進行分析。運用JOA評分進行術(shù)前和術(shù)后SCI神經(jīng)功能變化進行評估。[結(jié)果]對229例患者進行住院治療評估和隨訪分析,術(shù)后發(fā)生SCI加重者為32例,發(fā)生率13.97%;根據(jù)JOA評分標準,32例SCI加重患者術(shù)前JOA評分為14.6±1.8,術(shù)后1個月末次隨訪JOA評分12.2±1.2,統(tǒng)計學分析,P0.05,具有統(tǒng)計學意義。單因素分析性別、放置引流因素和病變節(jié)段等,P0.05,差異無統(tǒng)計學意義;高齡、脊髓受壓程度、腫瘤是否位于脊髓腹側(cè)等因素,P0.05,差異有統(tǒng)計學意義。多因素logistic回歸模型進行多元性分析:高齡、脊髓受壓嚴重、病變位于腹側(cè)和病變具有侵襲性是SCI術(shù)后加重的危險因素差異具有統(tǒng)計學意義(P0.05)。激素使用研究組的不同時期JOA評分變化進行組內(nèi)分析,(P0.05),差異具有統(tǒng)計學意義。[結(jié)論]1.在進行性脊髓外壓迫性疾病中當壓迫超過椎管內(nèi)直徑的1/2時,術(shù)前和術(shù)后顯示脊髓損傷嚴重,神經(jīng)功能的恢復差且時間較長,證實了早期治療的價值;2.合理的使用激素對于脊髓外壓迫解除后脊髓功能的恢復非常重要,尤其對于病變體積大、脊髓受壓嚴重和病變位于腹側(cè)及腹外側(cè)者;3.脊髓外壓迫性病變性質(zhì)、所在的節(jié)段和位置的不同,術(shù)后脊髓損傷加重不同;4.椎管內(nèi)脊髓病變手術(shù)需嚴謹、輕柔、精確的手術(shù)操作技巧和經(jīng)驗,尤其在切除腹側(cè)和具有侵襲性的腫瘤時對脊髓保護、降低手術(shù)操作副損傷的重要性。
[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 鹵1.8 in 32 patients with SCI aggravation, and the JOA score was 12.2 鹵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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.2

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