本文選題：椎管內(nèi)腫瘤 + 脊髓損傷��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]1.探討分析進(jìn)行性脊髓髓外受壓脊髓損傷以及脊髓損傷加重的危險(xiǎn)因素;2.分析激素在脊髓受壓脊髓損傷手術(shù)患者中的應(yīng)用價(jià)值;3.為臨床上椎管內(nèi)脊髓壓迫性病變患者的治療和神經(jīng)功能恢復(fù)提供參考。[方法]病例資料:收集我科2014年6月-2017年2月期間收治的椎管內(nèi)脊髓壓迫性病變患者手術(shù)前和手術(shù)后的臨床資料。根據(jù)研究設(shè)計(jì)標(biāo)準(zhǔn),納入研究的患者有229例。所有患者均采取后正中入路全椎板切除病變摘除脊髓減壓術(shù),術(shù)閉椎板還納椎管重塑。手術(shù)均由我科椎管內(nèi)病變手術(shù)熟練的副主任醫(yī)師職稱以上的醫(yī)師和同時(shí)具有副主任醫(yī)師職稱以上的麻醉醫(yī)師完成。229例患者在隨訪結(jié)束前均未進(jìn)行康復(fù)治療。根據(jù)可能影響SCI的因素包括:年齡、性別、脊髓受壓程度是否大于椎管內(nèi)直徑的1/2、術(shù)中激素使用、腫瘤與脊髓的相對(duì)位置和腫瘤的侵襲性等分別進(jìn)行單因素分析。單因素分析顯著性變化的進(jìn)入非條件性多因素logistic回歸模型進(jìn)行多元性分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。多因素logistic回歸模型進(jìn)行多元性分析顯示:脊髓受壓程度是否大于椎管內(nèi)直徑的1/2、年齡、脊髓受壓迫所在位置和階段以及腫瘤的侵襲性為相對(duì)獨(dú)立危險(xiǎn)因素,并對(duì)SCI加重者術(shù)前和術(shù)后JOA評(píng)分變化以及激素使用研究組的不同時(shí)期JOA評(píng)分變化進(jìn)行組內(nèi)分析對(duì)比研究。數(shù)據(jù)統(tǒng)計(jì)學(xué)處理:所有數(shù)據(jù)均采用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行分析。運(yùn)用JOA評(píng)分進(jìn)行術(shù)前和術(shù)后SCI神經(jīng)功能變化進(jìn)行評(píng)估。[結(jié)果]對(duì)229例患者進(jìn)行住院治療評(píng)估和隨訪分析,術(shù)后發(fā)生SCI加重者為32例,發(fā)生率13.97%;根據(jù)JOA評(píng)分標(biāo)準(zhǔn),32例SCI加重患者術(shù)前JOA評(píng)分為14.6±1.8,術(shù)后1個(gè)月末次隨訪JOA評(píng)分12.2±1.2,統(tǒng)計(jì)學(xué)分析,P0.05,具有統(tǒng)計(jì)學(xué)意義。單因素分析性別、放置引流因素和病變節(jié)段等,P0.05,差異無統(tǒng)計(jì)學(xué)意義;高齡、脊髓受壓程度、腫瘤是否位于脊髓腹側(cè)等因素,P0.05,差異有統(tǒng)計(jì)學(xué)意義。多因素logistic回歸模型進(jìn)行多元性分析:高齡、脊髓受壓嚴(yán)重、病變位于腹側(cè)和病變具有侵襲性是SCI術(shù)后加重的危險(xiǎn)因素差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。激素使用研究組的不同時(shí)期JOA評(píng)分變化進(jìn)行組內(nèi)分析,(P0.05),差異具有統(tǒng)計(jì)學(xué)意義。[結(jié)論]1.在進(jìn)行性脊髓外壓迫性疾病中當(dāng)壓迫超過椎管內(nèi)直徑的1/2時(shí),術(shù)前和術(shù)后顯示脊髓損傷嚴(yán)重,神經(jīng)功能的恢復(fù)差且時(shí)間較長(zhǎng),證實(shí)了早期治療的價(jià)值;2.合理的使用激素對(duì)于脊髓外壓迫解除后脊髓功能的恢復(fù)非常重要,尤其對(duì)于病變體積大、脊髓受壓嚴(yán)重和病變位于腹側(cè)及腹外側(cè)者;3.脊髓外壓迫性病變性質(zhì)、所在的節(jié)段和位置的不同,術(shù)后脊髓損傷加重不同;4.椎管內(nèi)脊髓病變手術(shù)需嚴(yán)謹(jǐn)、輕柔、精確的手術(shù)操作技巧和經(jīng)驗(yàn),尤其在切除腹側(cè)和具有侵襲性的腫瘤時(shí)對(duì)脊髓保護(hù)、降低手術(shù)操作副損傷的重要性。
[Abstract]:[objective] 1. Objective to investigate the risk factors of progressive spinal cord compression injury and exacerbation of spinal cord injury. To analyze the application value of hormone in patients with spinal cord compression injury. To provide a reference for the treatment and recovery of neurologic function in patients with spinal cord compression lesion. [methods] case data: the clinical data of patients with spinal cord compression lesions treated in our department from June 2014 to February 2017 were collected before and after operation. According to the study design criteria, 229 patients were included in the study. All patients were treated with posterior median approach total laminectomy and spinal cord decompression. All the operations were performed by the doctors who were skilled in the operation of intraspinal diseases and the anesthesiologists who also had the titles of deputy chief physicians. All the 229 patients were not treated with rehabilitation before the end of follow-up. Univariate analysis was carried out according to the factors that might influence SCI, such as age, sex, degree of spinal cord compression greater than 1 / 2 of spinal canal diameter, intraoperative hormone use, relative position of tumor to spinal cord and tumor invasiveness. Univariate analysis of significant changes into the non-conditional multivariate logistic regression model for diversity analysis was statistically significant. The multivariate logistic regression model showed that the degree of spinal cord compression was greater than 1 / 2 of the spinal canal diameter, the age, the location and stage of spinal cord compression and the invasiveness of the tumor were relatively independent risk factors. The changes of JOA score before and after SCI exacerbation and the changes of JOA score at different stages in hormone use study group were analyzed and compared. Data statistics processing: all data were analyzed by SPSS 22. 0 statistical software. The changes of SCI nerve function were evaluated by JOA score before and after operation. [results] SCI exacerbation occurred in 32 cases after operation, and was evaluated and followed up in 229 cases. According to the JOA score, the preoperative JOA score was 14.6 鹵1.8 in 32 patients with SCI aggravation, and the JOA score was 12.2 鹵1.2 at the end of one month after operation, which was statistically significant (P 0.05). In univariate analysis, there was no significant difference in sex, placement of drainage factors and pathological segment (P0.05), but there was no significant difference in the elderly, spinal cord compression degree, tumor located in ventral side of spinal cord and so on (P0.05). Multivariate logistic regression model was used to analyze the multiple factors: the elderly, the severe compression of spinal cord, the location of the lesion in the ventral side and the invasiveness of the lesion were the risk factors of the aggravation after SCI. There was significant difference in the risk factors after SCI operation (P 0.05). The changes of JOA score in the study group were analyzed in group A (P 0.05 0. 05), and the difference was statistically significant. [conclusion] 1. In progressive extraspinal compression disease, when compression was more than 1 / 2 of the intraspinal diameter, the spinal cord injury was serious before and after operation, the recovery of nerve function was poor and the time was long, which confirmed the value of early treatment. Rational use of hormones is very important for the recovery of spinal cord function after decompression, especially for those with large size, severe compression of spinal cord and ventral and ventrolateral lesions. The spinal cord injury was aggravated by different levels and positions of the extracorporeal compression lesion. 4. The surgical techniques and experience of intraspinal spinal cord disease should be rigorous, gentle and precise, especially in the treatment of ventral and aggressive tumors, and the importance of surgical collateral injury should be reduced.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 喬軍杰;馬迅;;胸椎管狹窄癥術(shù)后脊髓損害加重的研究進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2015年23期

2 康曉萍;姜紅;吳春波;劉獻(xiàn)增;強(qiáng)峻;劉方;郭楊;肖丹青;劉婧伊;余靜;高旭光;安友仲;朱繼紅;朱鳳雪;;連續(xù)性視頻腦電圖監(jiān)測(cè)在重癥監(jiān)護(hù)病房意識(shí)障礙患者中的應(yīng)用價(jià)值[J];中華醫(yī)學(xué)雜志;2015年21期

3 徐寶占;徐坤;楊鐘會(huì);初明;;脊膜瘤侵襲行為的研究進(jìn)展[J];中華神經(jīng)外科疾病研究雜志;2015年01期

4 華凱;郭慶升;張善勇;;慢性脊髓壓迫減壓后脊髓缺血再灌注損傷的動(dòng)物實(shí)驗(yàn)研究[J];山東醫(yī)藥;2014年37期

5 朱莊臣;焦偉;蔡國(guó)棟;張輝;王俊勤;;大劑量甲強(qiáng)龍治療急性脊髓損傷后早期并發(fā)癥的研究[J];中國(guó)矯形外科雜志;2014年16期

6 孫延卿;陳雄生;曹東;朱巍;賈連順;;氫鹽水可抑制脊髓缺血再灌注損傷兔模型運(yùn)動(dòng)神經(jīng)元的凋亡[J];中國(guó)組織工程研究;2014年18期

7 肖惠生;郭之通;張弋;;神經(jīng)電生理監(jiān)測(cè)在聽神經(jīng)瘤手術(shù)中的應(yīng)用(附11例臨床分析)[J];中國(guó)臨床神經(jīng)外科雜志;2012年06期

8 鄭力恒;林宏生;李錦聰;謝林;吳昊;張國(guó)威;;脊髓損傷后急性期甲基強(qiáng)的松龍干預(yù)對(duì)脊髓神經(jīng)細(xì)胞凋亡的影響[J];中國(guó)脊柱脊髓雜志;2012年05期

9 馬華松;陳志明;楊濱;吳繼功;譚榮;王曉平;;脊柱畸形后路截骨術(shù)神經(jīng)并發(fā)癥分析[J];中華外科雜志;2012年04期

10 陳永剛;耿彬;王栓科;王翠芳;劉文忠;馬延超;;神經(jīng)節(jié)苷脂對(duì)大鼠脊髓損傷后微管相關(guān)蛋白-2表達(dá)的影響及意義[J];中國(guó)矯形外科雜志;2011年10期

，

本文編號(hào)：1804586