择期和急诊手术治疗寰枢椎节段椎管内占位性病变的疗效比较

摘要

目的 比较择期和急诊行寰枢椎节段椎管内占位性病变手术的疗效.方法 选取2010年5月至2015年4月在该院接受治疗的寰枢椎节段椎管内占位性病变患者32例,将患者分为急诊手术组(A组)14例和择期手术组(B组)18例.比较两组患者手术时间、术中出血量、JOA评分、ODI指数及VAS评分、术后影像学(MRI)改变情况和两组患者对疗效的满意度.结果 术后A组患者的JOA评分[(25.23±4.47)分]高于B组[(22.10±3.56)分],差异有统计学意义(P＜0.05).两组患者的ODI指数及VAS评分都有所下降,ODI指数A组(18.56±3.10)分,B组(21.56±4.37)分、VAS评分A组(1.89±0.53)分,B组(3.16±0.89)分,两组ODI指数比较差异有统计学意义(P＜0.05);两组VAS评分比较差异有统计学意义(P＜0.05).两组患者术前及术后1个月时脊髓功能分级(Frankel分级)比较,差异均无统计学意义(P＞0.05).A组手术时间[(120.23±9.02)min]与B组[(126.25±12.12)min]相比差异无统计学意义(P＞0.05);A组患者的术中出血量[(211.26±12.25) mL]与B组[(220.43±17.58)mL]相比差异无统计学意义(P＞0.05).治疗后1个月A组患者的满意度(92.56％)高于B组患者(72.22％),差异有统计学意义(P＜0.05).结论 急诊行寰枢椎节段椎管内占位性病变手术,能有效提高治疗效果,并且治疗后患者的满意度比较高,值得推广使用.%Objective To compare and explore the curative effects of elective operation and emergency operation in treating atlantoaxial vertebral segmental spinal canal space-occupying lesions.Methods Thirty-two patients suffering from atlanto-axial vertebral segmental spinal canal space-occupying lesions treated in our hospital from May 2010 to April 2015 were selected and divided into the emergency operation group (group A,n =14) and elective operation group (group B,n =18).The emergency and elective operations were adopted respectively.Then the operation time,intraoperative blood loss,JOA score,ODI index,VAS score,postoperative imaging(MRI) and effect satisfaction degree were compared between the two groups.Results After treatment,the JOA score in the group A was (25.23±4.47) points,which was higher than (22.10±3.56) points in the group B,and the difference was statistically significant (t=3.67,P＜0.05).The ODI index and VAS score of the two groups all were decreased.The ODI index in the group A was (18.56±3.10) points,which in the group B was (21.56±4.37) points,and there was statistically significant difference between the two groups (t=3.76,P＜0.05).The VAS score in the group A was (1.89 ±-0.53)points,which in the group B was (3.16±0.89)points,the difference was statistically significant between the two groups (t=3.76,P＜0.05).Before surgery and at postoperative 1 month,the spinal cord function classification(Frankel grade) of the two groups had no statistically significant difference between the two groups(Z=-0.18,P=0.85＞0.05,Z=-0.52,P=0.60＞0.05).The operation time had no statistical difference between the group A and B[(120.23±9.02)min vs.(126.25±12.12)min,P＞0.05].The intraoperative bleeding volume had had no statistical difference between the group A and B [(211.26±12.25)mL vs.(220.43±17.58)mL,P＞ 0.05].After one month of treatment,the satisfaction degree in the group A was 92.56 ％,which was higher than 72.22％ in the group B,and the difference was statistically significant (Z=-2.13,P＜0.05).Conclusion Emergency operation in treating atlantoaxial segment spinal space occupying lesions can effectively improve the therapeutic effect,and has higher patients satisfaction after treatment.Therefore which is worth promoting and applying.