经部分半椎板入路切除椎管内神经鞘瘤的疗效评价

Effect of partial semi-laminectomy on limb feeling and motion function of schwannoma patients

目的比较经部分半椎板手术入路和经典半椎板入路治疗椎管内神经鞘瘤的疗效及安全性。方法2016年11月~2019年1月行部分半椎板入路切除的椎管内神经鞘瘤病人55例为研究组,同期行经典半椎板切除入路治疗的椎管内神经鞘瘤病人61例为对照组。比较两组肿瘤全切率、手术切口长度、术后切口感染率、术中失血量、手术时间、术后VAS疼痛评分、术后肌力恢复情况以及脊柱畸形发生率。结果两组病人肿瘤全切率、术后脊柱畸形发生率、术后肌力改善比较,差异均无统计学意义(P>0.05);研究组术后24小时以及48小时VAS评分低于对照组,差异有统计学意义(P<0.05);与对照组比较,研究组手术切口小、术后切口感染率低、术中失血量少、手术时间短,差异有统计学意义(P<0.05)。结论经部分半椎板入路治疗椎管内神经鞘瘤,创伤小、手术风险低,且不增加术后早期和晚期并发症发生率,不影响肿瘤全切率。

Objective To compare the efficacy and safety of the partial hemilaminectomy approach and the classic hemilaminectomy approach.Methods A total of 55 patients with intraspinal schwannoma who underwent partial hemilaminectomy from November 2016 to January 2019 in First Affiliated Hospital of Chongqing Medical University were collected as the research group,and 61 patients with intraspinal schwannoma at the same period who treated with classic hemilaminectomy served as a control group.The differences in tumor total resection rate,surgical incision length,postoperative incision infection rate,intraoperative blood loss,operation time,postoperative VAS pain score,postoperative motor sensory evaluation,and incidence of spinal deformity were compared and analyzed between the two groups.Results There was no significant difference between the two groups in tumor total resection rate,postoperative spinal deformity rate,postoperative movement sensory improvement rate(P>0.05);the VAS scores of the research group at 24 h and 48 h were significantly lower than those of the control group(P<0.05).Compared with the control group,cases in the research group had small surgical incisions,low postoperative incision infection rate,less intraoperative blood loss,and short operation time,with significant differences(P<0.05).Conclusion Treatment of intraspinal schwannoma via partial hemilaminar approach has less trauma,low surgical risk,and does not increase the incidence of early or late period postoperative complications,does not affect the tumor total resection rate.