硬脊膜动静脉瘘治疗预后相关因素分析——一种新的手术预后评分系统

An analysis of prognostic factors for spinal dural arteriovenous fistulas:A new surgical prognosis scoring system

目的硬脊膜动静脉瘘(Spinal dural arteriovenous fistulas,SDAVFs)患者预后因素分析.方法通过对中国医科大学附属第一医院2012年1月至2017年12月间收治的41例SDAVFs患者的流行病学特征、影像学特点、治疗方法及随访结果等资料进行回顾性分析.分为手术治疗组30例(SDAVFs切断术,不包括SDAVFs栓塞术)及非手术治疗组11例(拒绝手术,选择药物或物理治疗者),运用Aminoff and Logue评分(Aminoff and Logue Score,ALS)量化脊髓功能情况,分析SDAVFs患者治疗预后的相关因素.结果手术治疗组影像学治愈率100%,临床症状改善率36.7%(11/30),症状无变化者63.3%(19/30),临床症状加重者0%(0/30);非手术治疗组,临床症状改善率0%(0/11),症状无变化者27.3%(3/11),临床症状加重者72.7%(8/11);手术治疗能够明显改善SDAVFs患者功能预后(P=0.017);而患者治疗时年龄(P=0.020)、患病时间(P=0.037)、迂曲扩张的引流静脉长度(P=0.020)及患病当时临床症状严重程度(P=0.035)与患者手术预后有统计学意义,并提出全新的SDAVFs手术预后评分系统,7~8分为术后临床症状改善率高,而4~6分为术后临床症状改善不明显(P=0.000).结论SDAVFs切断术影像学治愈率极高,且相对于非手术治疗组的临床症状改善率亦较明显;根据相关预后因素(年龄、患病时间、迂曲扩张的引流静脉长度及患病当时的临床症状严重程度)提出的硬脊膜动静脉瘘手术预后评分系统,可用来评估预后.

Objective To analyze the prognostic factors in patients with spinal dural arteriovenous fistulas(SDAVFs).Methods The epidemiological characteristics,imaging features,treatment methods,and follow-up results of 41 patients with SDAVFs admitted to The First Affiliated Hospital of China Medical University from January 2012 to December 2017 were retrospectively analyzed.The patients were divided into surgical group(SDAVFs interruption surgery,SDAVFs embolization not included)(30 cases)and non-surgical group(drug or physical therapy instead of surgical procedure)(11 cases).The Aminoff and Logue Score(ALS)was used to quantify spinal cord function and to analyze the prognostic factors for SDAVFs.Results In the surgical group,the imaging cure rate was 100%(30/30),the clinical symptom improvement rate was 36.7%(11/30),non-response rate was 63.3%(19/30),and the deterioration rate was 0%(0/30);in comparison,the clinical improvement rate,non-response rate,and deterioration rate for non-surgical group were 0%(0/11),27.3%(3/11),and 72.7%(8/11),respectively.The results indicated that surgery was associated with significant improvement in SDAVFs prognosis(P=0.017).Additionally,patient age(P=0.020),duration of disease(P=0.037),length of the varicose draining vein(P=0.020),and clinical severity on admission(P=0.035)were significantly associated with the prognosis of the patients.A new surgical prognosis scoring system for SDAVFs was therefore proposed.A score of 7-8 denotes a high clinical symptom improvement rate,while a score of 4-6 indicates non-significant clinical improvement after surgery(P=0.000).Conclusions SDAVFs interruption surgery is associated with an extremely high imaging cure rate,and the improvement rate of clinical symptoms of surgical treatment is also higher compared with that of non-surgical treatment..The SDAVFs surgical prognosis scoring system proposed based on relevant prognostic factors(patient age,duration of disease,length of the varicose draining vein,and clinical severity on admission)can be used to assess the prognosis of SDAVFs surgery.