显微镜下微创通道手术切除腰椎椎管内占位性病变的疗效

Efficacy of microsurgical resection of lumbar intraspinal lesions using minimally invasive tubular retractor system

目的探讨显微镜下微创通道手术切除腰椎椎管内占位性病变的手术方式和疗效。方法回顾性分析山西省人民医院神经外科2016年3月至2018年3月采用手术治疗的26例腰椎椎管内髓外占位性病变(硬膜下24例,硬膜外2例)患者的临床资料。其中24例病变长度<3 cm;2例病变为多节段,其中1例病变长度为7 cm,1例为22 cm;均采用神经电生理监测下显微镜微创通道手术切除病变。采用疼痛视觉模拟评分(VAS)标准评估局部疼痛的改善程度,采用日本骨科学会(JOA)评分标准评估脊髓功能的改善情况;影像学随访关节突损伤程度及脊柱稳定性。结果26例患者的病变均为全切除,术后无神经功能障碍加重、脑脊液漏及感染者。术后随访时间为12~16(13.6±1.3)个月。16例神经根疼痛患者术后3个月疼痛均完全缓解,VAS评分中位数由术前的7分(5~9分)降至0分(0~1)分;术后12个月,26例患者的JOA评分由术前的(11.4±1.7)分恢复至(25.7±0.9)分。与术前比较,VAS评分和JOA评分差异均有统计学意义(均P<0.01)。CT复查显示关节突及脊柱稳定性均未受影响,随访期影像学证实病变无一例复发。结论神经电生理监测下显微镜微创通道手术切除腰椎椎管内较小的占位性病变及多节段囊性病变,全切除率高、并发症少,对肌肉、关节突关节损伤小,脊柱稳定性好。

Objective To explore the operative techniques and surgical efficacy of microsurgical resection of lumbar intraspinal lesions using minimally invasive tubular retractor system.Methods A retrospective analysis was conducted on the clinical data of 26 patients with lumbar intraspinal tumors(subdural lesion in 24 cases and extradural in 2)who underwent surgical treatment at Department of Neurosurgery,Shanxi Provincial People's Hospital from March 2016 to March 2018.Among them,the lesion was less than 3 cm in length in 24 cases and multiple segments were involved in the remaining 2 cases including 1 with the length of 7 cm and 1 of 22 cm.All the lesions were resected by microsurgery using minimally invasive tubular retractor system assisted with electrophysiological monitoring.The improvement of local pain was evaluated by visual analogue scale(VAS).The improvement of spinal cord function was evaluated based on Japanese Orthopedic Association(JOA)score.The degree of articular process injury and spinal stability were assessed by imaging follow-up.Results All 26 patients underwent total resection of lesions without exacerbation of neurological dysfunction,cerebrospinal fluid leakage or infection.Postoperative follow-up time was 12-16 months(13.6±1.3 months).At 3 months post surgery,the radicular pain of 12 patients was completely relieved.The median VAS score reduced from 7(5-9)to 0(0-1).At 12 months post operation,the JOA score of 26 patients recovered from 11.4±1.7 points to preoperative 25.7±0.9 points.The differences in both VAS and JOA scores were statistically significant(both P<0.01).Re-examination of CT showed that the stability of articular process or spine was not affected,and the imaging follow-up revealed no recurrence.Conclusions Under electrophysiological monitoring,the microsurgical resection using minimally invasive tubular retractor system could be performed for small space-occupying lesions and multi-segmental cystic lesions in the lumbar spinal canal,which seems to be associated with relatively high rate of complete resection,few complications,small damage to muscles and facet joints,and good spinal stability.