颈段椎管内肿瘤患者显微手术后的预后状况及其影响因素

Prognosis and influencing factors of patients with cervical intraspinal tumor after microsurgery

目的探讨颈段椎管内肿瘤患者显微手术后的预后状况及其影响因素。方法回顾性分析2016年4月至2022年3月于西安交通大学附属红会医院神经外科行显微手术的100例颈段椎管内肿瘤患者的临床资料,依据格拉斯哥预后评分(GOS)评估其预后状况,依据预后状况将患者分为预后良好组(GOS评分>3分)79例和预后不良组(GOS评分≤3分)21例。比较两组患者的临床资料,采用多因素Logistic回归法分析影响颈段椎管内肿瘤患者显微手术后预后的因素。结果单因素分析结果显示,年龄、手术方式、肿瘤直径与性质、肿瘤切除程度、术前肌力状况、术前JOA评分、神经电生理术中监测状况、术后应用激素均与颈段椎管内肿瘤患者显微术后的预后有关(P<0.05);经多因素Logistic回归分析结果显示,年龄超过60岁、肿瘤直径≥4 cm、恶性肿瘤、全椎板手术、肿瘤次切除、术前肌力<3级、神经电生理术中未监测、术后不使用激素、术前JOA评分较低均为颈段椎管内肿瘤患者显微手术后预后不良的独立危险因素(P<0.05)。结论颈段椎管内肿瘤患者显微手术后预后状况良好,预后不良的独立危险因素包括年龄>60岁、术前肌力<3级、恶性肿瘤、肿瘤直径≥4 cm、全椎板手术、肿瘤次切除、神经电生理术中无监测、术后不使用激素、术前JOA评分较低。

Objective To investigate the prognosis and influencing factors of patients with cervical intraspinal tumors after microsurgery.Methods The clinical data of 100 patients with cervical intraspinal tumors who underwent microsurgery in Department of Neurosurgery,Honghui Hospital Affiliated to Xi'an Jiaotong University from April 2016 to March 2022 were retrospectively analyzed,and their prognosis was evaluated according to Glasgow prognostic score(GOS).According to the prognosis,the patients were divided into a good prognosis group(GOS score>3,79 cases)and a poor prognosis group(GOS score≤3 points,21 cases).The clinical data of the two groups were compared,and the factors influencing the prognosis of patients with cervical intravertebral tumors after microsurgery were analyzed by multivariate Logistic regression.Results Univariate analysis showed that age,surgical method,tumor diameter and nature,degree of tumor resection,preoperative muscle strength,preoperative JOA score,intraoperative neuroelectrophysiological monitoring,and postoperative hormone use were all correlated with the prognosis of patients with cervical intravertebral tumor after microsurgery(P<0.05).The results of multiple Logistic regression analysis showed that age over 60 years old,tumor diameter≥4 cm,malignant tumor,total laminectomy,secondary tumor resection,preoperative muscle strength<grade 3,no intraoperative monitoring during neuroelectrophysiology,no postoperative hormone use,and low preoperative JOA score were all independent risk factors for poor prognosis in patients with cervical intravertebral tumor after microsurgery(P<0.05).Conclusion The prognosis of patients with cervical intraspinal tumors after microsurgery is good,and independent risk factors for poor prognosis included age>60 years old,preoperative muscle strength<grade 3,malignant tumor,tumor diameter≥4 cm,total laminectomy,secondary tumor resection,no intraoperative monitoring during neuroelectrophysiology,no postoperative hormone use,and low preoperative JOA score.