显微镜下部分椎板切除手术治疗椎管内脊膜瘤的疗效观察

Clinical efficacy of microscopic partial laminectomy in treatment of intradural spinal meningioma

目的观察显微镜下部分椎板切除手术治疗椎管内脊膜瘤的临床疗效。方法回顾性分析自2015-01—2020-12采用显微镜下部分椎板切除手术治疗的43例椎管内脊膜瘤(砂粒体型22例,脑膜上皮型17例,过渡型2例,血管瘤型2例),比较术前、术后1周、末次随访时疼痛VAS评分和McCormick脊髓功能评分。结果43例均获得随访,随访时间为26~41个月,平均32.3个月。术后脊柱三维CT检查未发现肿瘤所在节段椎体小关节突破坏,脊柱稳定性未破坏。术后复查MRI显示肿瘤均全部切除。术前McCormick脊髓功能评分:Ⅰ级10例,Ⅱ级18例,Ⅲ级8例,Ⅳ级7例。术后1周McCormick脊髓功能评分:Ⅰ级17例,Ⅱ级14例,Ⅲ级5例,Ⅳ级7例。末次随访时McCormick脊髓功能评分:Ⅰ级34例,Ⅱ级7例,Ⅲ级2例。术后McCormick脊髓功能评分较术前明显改善,差异有统计学意义(P<0.05)。术前疼痛VAS评分为(5.14±1.15)分,术后1周为(1.49±0.71)分,末次随访时为(0.91±0.48)分;术后1周疼痛VAS评分较术前明显降低(P<0.05),末次随访时疼痛VAS评分较术后1周降低(P<0.05)。结论显微镜下部分椎板切除手术治疗椎管内脊膜瘤可取得满意疗效,术中能充分显露脊膜瘤并直视下全切除,手术安全性高,可以有效保护脊髓,不影响椎体稳定性,可以显著改善患者预后。

Objective To observe the clinical effect of partial laminectomy in the treatment of intraspinal meningioma under microscope.Methods Forty-three patients with intraspinal meningiomas(22 cases of psammoma type,17 cases of meningeal epithelial type,2 cases of transitional type,and 2 cases of hemangioma type)treated by partial laminotomy under microscope from January 2015 to December 2020 were retrospectively analyzed.The VAS score and McCormick spinal cord function score were compared before operation,1 week after operation,and at the last follow-up.Results All patients were followed up for 26-41 months,with an average of 32.3 months.Postoperative three-dimensional CT examination of the spine showed that the facet joint of the tumor segment was not broken,and the spinal stability was not destroyed.Postoperative MRI showed that all tumors were completely removed.Preoperative McCormick spinal cord function score:10 cases of gradeⅠ,18 cases of gradeⅡ,8 cases of gradeⅢ,and 7 cases of gradeⅣ.McCormick spinal cord function score at 1 week after operation:17 cases of gradeⅠ,14 cases of gradeⅡ,5 cases of gradeⅢ,and 7 cases of gradeⅣ.At the last follow-up,McCormick spinal cord function score was gradeⅠin 34 cases,gradeⅡin 7 cases,and gradeⅢin 2 cases.The McCormick spinal cord function score after operation was significantly improved compared with that before operation(P<0.05).The VAS score was 5.14±1.15 before operation,1.49±0.71 at 1 week after operation,and 0.91±0.48 at the last follow-up.The VAS score of pain at 1 week after operation was significantly lower than that before operation(P<0.05),and the VAS score at last follow-up was significantly lower than that at 1 week after operation(P<0.05).Conclusion Partial laminotomy under microscope for the treatment of intraspinal meningiomas can achieve satisfactory results.During the operation,the meningiomas can be fully exposed and totally removed under direct vision.The operation is safe and can effectively protect the spinal cord without affecting the stability of the vertebral body,and can significantly improve the prognosis of patients.