Luoyang orthopedic hospital of Henan Province
分析显微镜下手术切除腰椎椎管内硬膜下肿瘤的疗效及对脊柱损伤的影响。[方法] 回顾性分析2016年4月~2019年4月在脊柱外科实施手术治疗的32例腰椎椎管内硬膜下肿瘤患者的临床资料。32例患者中男18例，女14例；年龄（48.87±7.50）岁，病程（8.65±2.50）个月；病灶部位：L13例、L25例、L2-33例、L38例、L410例、L53例。患者术前均经影像学检查明确肿瘤定位，实施实显微镜下手术切除治疗，术后随访6~12个月。记录患者的围术期情况，比较手术前后的疼痛、腰椎功能及脊髓损伤分级情况，记录两组随访期间的并发症情况。[结果] 32例患者均顺利完成手术，手术时间（135.35±28.57）min，术中出血（108.2±12.95）mL，术中未出现神经及脊髓损伤等并发症，术后住院时间（9.01±2.05）d，2例患者术后切口感染，经对症治疗后好转。随访时间（9.03±2.01）个月，随访期间患者疼痛、肢体麻木、乏力等症状均好转，肌力基本恢复正常，未见肿瘤复发及脊柱畸形。与术前比较，术后视觉模拟疼痛评分（VAS）评分随时间延长而降低，日本骨科协会脊髓功能评分（JOA）随时间延长而增加（P<0.001）。术前及术后6个月Frankel等级分布比较，差异有统计学意义（P＜0.001），术后6个月Frankel分级E级占比高于术前，差异有统计学意义（P＜0.001）。[结论] 腰椎椎管内硬膜下肿瘤采用显微镜下手术切除具有创伤小、恢复快的特点，可有效恢复脊髓功能，且并发症发生风险低。
To analyze the effect of microsurgical resection of lumbar intraspinal subdural tumor and its influence on spinal injury. [Methods] A retrospective analysis of the clinical data of 32 patients with lumbar intraspinal subdural tumors who underwent surgical treatment in spinal surgery from April 2016 to April 2019. Among the 32 patients, 18 were males and 14 were females, age (48.87±7.50) years old, course of disease (8.65±2.50) months, lesion location: L13 cases, L25 cases, L2-33 cases, L38 cases, L410 cases, L53 cases. All patients were confirmed by imaging examination before operation, and were operated under real microscope, postoperative followed up for 6-12 months. The perioperative condition of the patients was recorded. Pain, lumbar function and spinal cord injury classification were compared before and after operation. The complications during follow-up were recorded. [Results] All 32 patients successfully completed the operation. The operation time was (135.35±28.57) min, the intraoperative blood loss was (108.2±12.95) mL, there were no complications such as nerve and spinal cord injury during the operation, and the postoperative hospital stay was (9.01 ± 2.05) d, 2 patients with postoperative wound infection, which improved after symptomatic treatment. The postoperative follow-up time was (9.03±2.01) months, during the follow-up period, the symptoms of pain, limb numbness, fatigue and other symptoms all improved, and muscle strength basically returned to normal, and no tumor recurrence and spinal deformity were found. Compared with preoperatively, the postoperative visual analogue scale (VAS) score decreased with time, and the Japanese orthopaedic association scores (JOA) score increased with time, the difference was statistically significant(P<0.001). There was a statistically significant difference in Frankel grade distribution before and 6 months after operation (P<0.001). The proportion of Frankel grade E at 6 months after operation was higher than that before operation, the difference was statistically significant (P<0.001). [Conclusion] Microsurgical resection of lumbar intraspinal subdural tumor has the characteristics of small trauma and quick recovery, which can effectively restore the spinal cord function and has low risk of complications.