转移瘤硬膜外脊髓压迫症运动功能障碍与影像学及临床特征相关性分析

Single factor analysis of motor dysfunction and imaging and clinical features in metastatic epidural spinal cord compression

目的:探讨转移瘤硬膜外脊髓压迫症(metastatic epidural spinal cord compression,MESCC)运动功能障碍与影像学及临床特征的相关性。方法:自2006年7月至2008年12月对连续收治的26例MESCC患者43个主要病变椎体进行MRI及CT扫描评估,并进行运动功能障碍评分。结果:26例MESCC患者中,12例发生内脏转移,其中10例发生运动功能障碍;14例无内脏转移,其中4例发生运动功能障碍(P=0.0079)。主要病变椎体连续组中,16椎发生运动功能障碍;主要病变椎体非连续组中,9椎发生运动功能障碍(P=0.1034)。主要病变椎体累及椎板组中,11椎发生运动功能障碍;主要病变椎体未累及椎板组中,14椎发生运动功能障碍(P=0.0205)。主要病变椎体后壁向后突出组中,12椎发生运动功能障碍;主要病变椎体后壁无向后突出组中,13椎发生运动功能障碍(P=0.0334)。侵犯椎管内硬膜外组织组中,11椎发生运动功能障碍;未侵犯椎管内硬膜外组织组中,14椎发生运动功能障碍(P=0.0036)。转移瘤患者年龄、性别、术前接受正规化疗、转移灶部位腰背部疼痛程度、原发肿瘤已行根治手术、原发肿瘤治疗效果、脊柱外骨转移灶数目、主要受累脊椎数目、主要病变椎体节段、连续病变椎体节段、累及椎体、椎体前柱骨折、椎体后壁骨折、累及椎弓根等因素对MESCC运动功能障碍影响均无统计学意义(P>0.05)。结论:发生内脏转移、主要病变椎体累及椎板、椎体后壁向后突出、转移瘤侵犯椎管内硬膜外组织的MESCC较易发生运动功能障碍,转移瘤连续病椎的发生率于颈椎和上胸椎组最高。

To explore the relationship of motor dysfunction of the lower extremities with the imaging appear- ances and clinical features of metastatic epidural spinal cord compression （MESCCs）. Methods：From July 2006 to December 2007,26 successive patients with metastases of the thoracic, lumbar and the cervical spine were treated in our department. Forty-three main involved vertebra in all 26 patients were evaluated by magnetic resonance imaging and computed tomogra- phy, and were scored according motor dysfunction in this study. Fourteen patients （25 vertebrae） had motor dysfunction. Re- sults：Among 26 patients, 12 cases with visceral metastasis,in which had motor dysfunction in 10 cases; 14 cases without vis- ceral metastasis,in which had motor dysfunction in 4 cases;comparison between two groups,P=-0.007 9. Among vertebral pres- ence of continuity of 43 main involved vertebrae, 16 vertebrae had motor dysfunction ; among vertebral absence of continuity, motor dysfunction occurred in 9 vertebrae, comparison between two groups, P=0.103 4. Among vertebral presence of lamina in- volvement of 43 main involved vertebrae, 11 vertebrae had motor dysfunction ; among vertebral absence of lamina involvement, motor dysfunction occurred in 14 vertebrae, comparison between two groups,P=0.020 5. Among vertebral presence of protrud- ing of vertebral posterior wall of 43 main involved vertebrae, 12 vertebrae had motor dysfunction;among vertebral absence of protruding of vertebral posterior wall, 13 vertebrae had motor dysfunction, comparison between two groups, P=0.033 4. Among vertebral presence of involvement epidural space of 43 main involved vertebrae, 11 vertebrae had motor dysfunction ; among vertebral absence of involvement epidural space, 14 vertebrae had motor dysfunction, comparison between two groups, P=0.003 6. Such factors as age, gender, whether or not received regular chem before admission, back pain degree of metastasis, received regular chem before admission, therapeutic efficacy of primary tumor, number of bony metastases outside spine, number of the main involved vertebrae, level of vertebral metastases location, level of continuous involved vertebrae, vertebral-body involve- ment, fracture of anterior column, fracture of posterior wall, and pedicle involvement had no effects on incidence of motor dys- function due to MESCC （/：＇〉0.05）. Conclusion：MESCC with visceral metastases,lamina involvement,presence of outstandingbuttocks sign of posterior wall,involvement epidural space tended to cause symptomatic MESCC. Incidence of continuity of main involved vertebrae occurred more frequently in the CUTS compared with other levels of spine.