Huang Lin, Guo Wei, Yang Rongli, Tang Xiaodong, Ji Tao
Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, PR China.
Spine (Phila Pa 1976). 2016 Apr;41(7):628-37. doi: 10.1097/BRS.0000000000001274.
Cross-section analysis.
A quality-of-life oriented scoring system for evaluation of lower limbs, bladder, and bowel functions of patients after sacral tumor resection has been proposed and was adopted in a clinical research.
Surgical resections of sacral tumors usually cause postoperative neurologic deficits. A widely agreed scoring system for detailed evaluation of functional outcomes is not yet established.
The scoring system has three domains with three items in each domain, being allocated 0 to 3 points of each item according to the degree of functional impairment. Overall function scale is presented in percentage form. In the current single-center cross-section study, it was adopted to evaluate and quantify the postoperative functional outcomes of 170 consecutive patients who underwent sacrectomy.
Significant observer agreement (P < 0.01) was found in all nine items of the proposed system. Detailed functional outcome and difference between each group can be well described by the scoring results. Preservation of bilateral S1 nerve roots preserved majority of motor and sensory function in lower limbs. The probability and degree of urine incontinence (P = 0.003) and abnormal bladder sensation (P = 0.039) was significantly lower in patients with bilateral S3 nerve preserved than those whose unilateral S3 was severed. Patients with unilateral S3 preserved had a lower incidence and degree of dysuria (P = 0.056), constipation (P = 0.059), bowel incontinence (P = 0.007), and abnormal rectal sensation (P = 0.002) than those whose bilateral S3 were sacrificed. Functional outcomes for patients with retained coccyx were better than those with coccyx transected. Functional outcome of different level sacral nerve preservation was semi-quantified and profiled.
Detailed and intuitive description of neurologic deficits after sacral tumor resection is the major purpose of current scoring system. The ease of use and reproducibility makes it a practical tool to evaluate function status after sacrectomy under oncologic condition.
横断面分析。
提出一种以生活质量为导向的评分系统，用于评估骶骨肿瘤切除术后患者的下肢、膀胱和肠道功能，并在一项临床研究中采用。
骶骨肿瘤手术切除通常会导致术后神经功能缺损。尚未建立一个广泛认可的用于详细评估功能结果的评分系统。
该评分系统有三个领域，每个领域有三个项目，根据功能损害程度为每个项目分配0至3分。总体功能量表以百分比形式呈现。在当前的单中心横断面研究中，采用该评分系统评估和量化170例连续接受骶骨切除术患者的术后功能结果。
在所提出系统的所有九个项目中均发现显著的观察者一致性（P<0.01）。评分结果可以很好地描述详细的功能结果以及每组之间的差异。保留双侧S1神经根可保留下肢的大部分运动和感觉功能。保留双侧S3神经的患者尿失禁（P=0.003）和膀胱感觉异常（P=0.039）的概率和程度明显低于单侧S3神经切断的患者。保留单侧S3神经的患者排尿困难（P=0.056）、便秘（P=0.059）、大便失禁（P=0.007）和直肠感觉异常（P=0.002）的发生率和程度低于双侧S3神经切断的患者。保留尾骨的患者的功能结果优于尾骨横断的患者。对不同水平骶神经保留的功能结果进行了半定量和分析。
当前评分系统的主要目的是对骶骨肿瘤切除术后的神经功能缺损进行详细直观的描述。其易用性和可重复性使其成为评估肿瘤条件下骶骨切除术后功能状态的实用工具。
4级。
