中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
6期
15-17
,共3页
连冲%王利民%宋瑞鹏%赵家邦
連遲%王利民%宋瑞鵬%趙傢邦
련충%왕이민%송서붕%조가방
胸椎血管瘤%脊髓压迫%骨水泥%全椎体切除%椎弓根螺钉系统
胸椎血管瘤%脊髓壓迫%骨水泥%全椎體切除%椎弓根螺釘繫統
흉추혈관류%척수압박%골수니%전추체절제%추궁근라정계통
Thoracic vertebrae hemangioma%Spinal cord compression%Bone cement%Spine removed%Pedicle screw system
目的 回顾性分析有脊髓压迫症状的胸椎血管瘤的两种手术效果,探讨哪种手术方式更值得推广.方法 收集郑州大学第一附属医院2008年1月至2012年2月收治的有脊髓压迫症状的胸椎血管瘤患者21例,根据手术方式分为A、B两组:A组10例采用360.全椎体切除+椎体重建植骨融合椎弓根螺钉内固定术；B组11例采用经椎弓根骨水泥注入术+椎管减压椎弓根螺钉内固定术,术后均行常规放疗.随访6～18个月,平均(10.0±2.3)个月,根据治疗前后及随访期间患者的临床表现,以疼痛视觉模拟评分(VAS)和日本骨科协会(JOA)评分,评定两组患者术后疼痛缓解及神经功能恢复情况,进行统计学分析.结果 21例患者神经症状均大部分缓解.术中出血量B组[(910±50)ml]明显少于A组[(1450±30)ml],P＜0.05；术后第3天、6个月及末次随访时A、B两组VAS及JOA评分均较术前明显改善(P＜0.05)；术后第3天,B组两项评分(JOA 10.2 ±2.5、VAS 3.8 ±0.8)明显优于A组(JOA 7.8 ±1.9、VAS 5.1±1.0),P＜0.05；6个月及末次随访时A、B两组间比较差异无统计学意义(P＞0.05).结论 经椎弓根骨水泥注入术+椎管减压椎弓根螺钉内固定术治疗,患者术后恢复快,出血量明显减少,长期疗效好,是一种更好的手术方法.
目的 迴顧性分析有脊髓壓迫癥狀的胸椎血管瘤的兩種手術效果,探討哪種手術方式更值得推廣.方法 收集鄭州大學第一附屬醫院2008年1月至2012年2月收治的有脊髓壓迫癥狀的胸椎血管瘤患者21例,根據手術方式分為A、B兩組:A組10例採用360.全椎體切除+椎體重建植骨融閤椎弓根螺釘內固定術；B組11例採用經椎弓根骨水泥註入術+椎管減壓椎弓根螺釘內固定術,術後均行常規放療.隨訪6～18箇月,平均(10.0±2.3)箇月,根據治療前後及隨訪期間患者的臨床錶現,以疼痛視覺模擬評分(VAS)和日本骨科協會(JOA)評分,評定兩組患者術後疼痛緩解及神經功能恢複情況,進行統計學分析.結果 21例患者神經癥狀均大部分緩解.術中齣血量B組[(910±50)ml]明顯少于A組[(1450±30)ml],P＜0.05；術後第3天、6箇月及末次隨訪時A、B兩組VAS及JOA評分均較術前明顯改善(P＜0.05)；術後第3天,B組兩項評分(JOA 10.2 ±2.5、VAS 3.8 ±0.8)明顯優于A組(JOA 7.8 ±1.9、VAS 5.1±1.0),P＜0.05；6箇月及末次隨訪時A、B兩組間比較差異無統計學意義(P＞0.05).結論 經椎弓根骨水泥註入術+椎管減壓椎弓根螺釘內固定術治療,患者術後恢複快,齣血量明顯減少,長期療效好,是一種更好的手術方法.
목적 회고성분석유척수압박증상적흉추혈관류적량충수술효과,탐토나충수술방식경치득추엄.방법 수집정주대학제일부속의원2008년1월지2012년2월수치적유척수압박증상적흉추혈관류환자21례,근거수술방식분위A、B량조:A조10례채용360.전추체절제+추체중건식골융합추궁근라정내고정술；B조11례채용경추궁근골수니주입술+추관감압추궁근라정내고정술,술후균행상규방료.수방6～18개월,평균(10.0±2.3)개월,근거치료전후급수방기간환자적림상표현,이동통시각모의평분(VAS)화일본골과협회(JOA)평분,평정량조환자술후동통완해급신경공능회복정황,진행통계학분석.결과 21례환자신경증상균대부분완해.술중출혈량B조[(910±50)ml]명현소우A조[(1450±30)ml],P＜0.05；술후제3천、6개월급말차수방시A、B량조VAS급JOA평분균교술전명현개선(P＜0.05)；술후제3천,B조량항평분(JOA 10.2 ±2.5、VAS 3.8 ±0.8)명현우우A조(JOA 7.8 ±1.9、VAS 5.1±1.0),P＜0.05；6개월급말차수방시A、B량조간비교차이무통계학의의(P＞0.05).결론 경추궁근골수니주입술+추관감압추궁근라정내고정술치료,환자술후회복쾌,출혈량명현감소,장기료효호,시일충경호적수술방법.
Objective To investigate which kind of surgery treatment is more worth promoting by reviewing the outcomes of two different surgical treatment about thoracic vertebral hemangioma with extraosseous extension causing spinal cord compression.Methods From Jan.2008 to Feb.2012,we investigated the two different surgical treatment of 21 cases of thoracic vertebral hemangioma(TVH) having spinal cord compression,which were divided into two groups (group A and group B).Group A:10 cases of patients with extraosseous extension and spinal cord compression were operated on through anterior approach to resect the involved vertebral body and intracanal angioma,and bone graft and internal fixation were also completed in one-stage; Group B:11 cases with bone cement injection,spinal decompression and internal fixation.Patients were followed up for 6 to 18 months,with an average of(10.0 ± 2.3) months.The recovery of neurological function and the pain relief were measured by visual analogue scale (VAS) score and Japanese orthopaedic association (JOA) score.Results In all 21 cases with neural lesion symptoms received open surgery with neurological symptoms partially regained.All patients of two groups were followed up.The blood loss during operation in group A was(1450 ±30) ml,the blood loss during operation in group B was(910 ±50) ml.The JOA score and VAS score had a significant recovery at 3 days,6 months and at last follow-up when compared with preoperative values (P ＜ 0.05); The difference between group A and group B was statistically significant at 3 days after surgery(P ＜0.05) ;The score of JOA and VAS of group B(JOA 10.2 ±2.5 and VAS 3.8 ±0.8) was significantly better than that of group A(JOA 7.8 ± 1.9 and VAS 5.1 ± 1.0) ; But there was no significant difference between the two groups in statistics at 6 months and at last follow-up(P ＞ 0.05).Conclusions The surgical treatment of bone cement injected by the pedicle,spinal decompression and pedicle screw fixation,is a better surgical techniques,because the patients' postoperative recovery is quick,and complications is significantly reduced.
