脊柱转移瘤患者术前神经功能障碍时间对术后早期神经功能恢复的影响

Effect of preoperative neurological dysfunction duration on short-term postoperative neurological recovery in patients with spinal metastases

中文关键词:  脊柱转移瘤  外科手术  术后早期  临床疗效

英文关键词:Spinal metastases  Surgery  Postoperative short-term  Clinical outcome

中文摘要:

  【摘要】 目的：分析脊柱转移瘤患者术前神经功能障碍时间对术后早期神经功能恢复的影响。方法：回顾性分析2021年1月~2023年12月于我院接受手术治疗的脊柱转移瘤患者120例，其中男68例，女52例，年龄58.5±11.6岁（27~82岁）。就诊时主要症状为受累节段的疼痛及神经功能损害。原发肿瘤为肺癌（38例），肾癌（21例），乳腺癌（13例），骨髓瘤15例，淋巴瘤5例，其他来源28例。采用经皮穿刺椎体成形术（percutaneous vertebroplasty，PVP）5例，全脊椎整块切除术（total en-bloc spondylectomy，TES）14例，脊柱肿瘤分离手术67例，病灶姑息性切除减压手术34例。分别在手术前和术后第5d采用疼痛数字评定量表（numerical rating scale，NRS）和美国脊柱损伤协会（American Spinal Injury Association，ASIA）脊髓损伤分级对患者进行评估。采用硬膜外脊髓压迫（epidural spinal cord compression，ESCC）评分系统评估脊髓压迫程度。统计术前ASIA分级为AB级以及C级患者受累平面以下肌力出现障碍至接受手术的时间，将其记录为术前神经功能障碍时间。对于术前ASIA分级AB级的患者选取术后7d、10d、15d三个时间点，C级的患者选取术后15d和30d两个时间点。对两组术后不同时间点神经功能改善率（术后ASIA分级较术前至少改善一级病例数目的比例）进行统计分析。结果：所有患者术中均进行充分减压以解除神经压迫（除PVP外），术后脊柱稳定性得到恢复。术后全部患者疼痛NRS评分显著降低[术前6.00（2.00）分vs 术后3.00（1.00）分，P=0.000]。部分患者神经功能在术后早期即刻得到改善，ASIA分级至少改善一级例数术前AB级17例（74%），C级10例（63%），D级18例（47%）。其中术前AB级与C级患者ESCC评分没有差异[3.00（1.00）分 vs 3.00（0.00）分，P=0.070]。对于术前ASIA分级AB级患者，术前神经功能障碍时间≤10d的术后早期神经功能改善率显著优于>10d组（>10d 57.1% vs ≤10d 100%，P=0.048）。对于术前ASIA分级C级患者，术前神经功能障碍时间≤30d的术后早期神经功能改善率显著优于>30d组（>30d 20.0% vs ≤30d 81.8%，P=0.036）。结论：脊柱转移瘤患者通过手术治疗术后早期即可缓解疼痛，术前神经功能障碍时间对术后早期神经功能的恢复具有显著的影响。

英文摘要:

  【Abstract】 Objectives: To analyze the influence of preoperative neurological dysfunction time on postoperative short-term neurological function recovery. Methods: A retrospective analysis was performed on 120 patients with spinal metastases who received surgical treatment from January 2021 to December 2023. There were 68 males and 52 females, aged 58.5±11.6 years(27-82 years). The main clinical symptoms were pain in the affected segment and neurological function impairment. The primary tumors were lung cancer(38 cases), kidney cancer(21 cases), breast cancer(13 cases), myeloma(15 cases), lymphoma(5 cases), and other sources of tumor(28 cases). The procedures used included percutaneous vertebroplasty(PVP) (5 cases), total en-bloc spondylectomy(TES) (14 cases), spinal tumor separation surgery(67 cases), and focal palliative excision decompression surgery(34 cases). Numerical rating scale(NRS) and American Spinal Injury Association(ASIA) spinal cord injury scale were used to evaluate the pain grade and nerve function of patients before surgery and on the 5th day after surgery, respectively. The degree of spinal cord compression was evaluated using the epidural spinal cord compression(ESCC) scoring system. The time period from muscle strength impairment below the affected plane to surgery for patients with ASIA AB and C was recorded as the time of preoperative neurological dysfunction. For patients with ASIA AB before surgery, three time points of 7d, 10d and 15d were selected. For patients with ASIA grade C before surgery, two time points were selected: 15d and 30d. The postoperative neurological improvement rate(the proportion of patients with at least one grade improvement of ASIA classification after surgery) of the two groups at different time points were calculated and analyzed. Results: Spinal stability was restored after surgery, and adequate decompression was performed to relieve nerve compression(except PVP). Postoperative NRS scores were significantly lower in all the patients[preoperative 6.00(2.00) vs postoperative 3.00(1.00), P=0.000]. The neurological function of some patients was improved immediately after operation, and the ASIA grade improved at least one grade in 17 patients(74%) of preoperative grades AB, 10 patients(63%) of preoperative grade C, and 18 patients(47%) of preoperative grade D. There was no difference in ESCC scores between patients with preoperative grade C and those with preoperative grades A and B[3.00(1.00) vs 3.00(0.00), P=0.070]. For patients with preoperative ASIA grades AB, the improvement rate of short-term postoperative neurological function in patients with preoperative neurological dysfunction ≤10d was significantly better than that in patients with >10d(>10d 57.1% vs ≤10d 100%, P=0.048). For patients with preoperative ASIA grade C, the improvement rate of short-term postoperative neurological function in patients with preoperative neurological dysfunction ≤30d was significantly better than that in patients with >30d(>30d 20.0% vs ≤30d 81.8%, P=0.036). Conclusions: Patients with spinal metastases can get pain relief in the short-term after surgery. The time of neurological dysfunction before surgery has a significant effect on the short-term recovery of neurological function after surgery.