脊柱转移瘤患者术后神经功能恢复影响因素分析

Analysis of related factors of postoperative neurological function recovery in patients with spinal metastases

目的分析脊柱转移肿瘤造成神经功能受损的患者术前神经功能障碍持续时间及受损程度与术后神经功能恢复的关系。方法将52例手术治疗的脊柱转移瘤患者,按术前神经功能障碍持续时间分为<2周、2~4周、>4周组3组;按神经受损程度(ASIA分级)分为A、B、C、D级4组。观察神经功能恢复等级。结果患者均获得随访,时间3~62个月。神经功能障碍持续时间<2周组和2~4周组神经提高等级均高于>4周组,差异有统计学意义(P<0.05);神经功能障碍持续时间<2周组与2~4周组比较神经提高等级差异无统计学意义(P>0.05)。受损程度为A级组神经提高等级低于其他3组,差异有统计学意义(P<0.05);受损程度为B、C、D级3组组间比较神经提高等级差异无统计学意义(P>0.05)。结论神经功能障碍持续时间与神经功能恢复密切相关,在神经功能障碍持续时间<4周手术神经功能仍能得到较大的恢复;神经受损的程度与神经功能恢复相关但并不密切;对具有手术指针并且能耐受手术的脊柱转移瘤患者仍需积极手术治疗。

Objective To analyze the relationship of the duration of preoperative neurological symptoms and the degree of involvement and functional recovery of patients with spinal metastases.Methods Fifty-two patients were divided into less than 2 weeks,2~4 weeks and more than 4 weeks groups respectively according to duration of preoperative neurological symptoms,simultaneously were divided into A,B,C and D grade group respectively according to degree of involvement refer to ASIA grade scale.Results All the patients were followed up from 3 months to 62 months.Postoperative neurological recovery grade in duration less than 2 weeks group and 2~4 weeks group werehigher than that in duration more than 4 weeks group （P〈0.05）,that between duration less than 2 weeks group and 2~4 weeks group had no significant difference （P〉0.05）.Postoperative neurological recovery grade in A group was lower than other groups （P〈0.05）,the neurological recovery of other three groups had no significant difference （P〉0.05）.Conclusions The duration of neurological symptoms is closely related to the recovery of neurological function and neurological function can get a great recovery if duration less than 4 weeks.The degree of involvement is related to the recovery of neurological function,but it is not close.Surgical treatment for patients with nerve involvement caused by spinal metastases is necessary.