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在硬脊膜外脊髓肿瘤患者中,肿瘤切除术后术前步态障碍的严重程度是否仍然存在?

Does the degree of preoperative gait disturbance remain after tumor resection in patients with intradural extramedullary spinal cord tumors?

机构信息

Department of Orthopaedics Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.

出版信息

Spinal Cord. 2023 Dec;61(12):637-643. doi: 10.1038/s41393-023-00931-0. Epub 2023 Aug 28.

Abstract

STUDY DESIGN

Retrospective comparative study.

OBJECTIVE

This study aimed to determine whether the degree of preoperative gait disturbance remains following surgical resection in patients with intradural extramedullary spinal cord tumors (IDEMSCTs), and to investigate any factors that may influence poor improvement in postoperative gait disturbance.

SETTING

The single institution in Japan.

METHODS

In total, 78 IDEMSCTs patients who required surgical excision between 2010 and 2019 were included. According to the degree of preoperative gait disturbance using modified McCormick scale (MMCS) grade, they were divided into the Mild and Severe groups. The mean postoperative follow-up period was 50.7 ± 17.9 months. Data on demographic and surgical characteristics were compared between the two groups.

RESULTS

There was no significant difference in terms of age at surgery, sex, tumor size, surgical time, estimated blood loss, tumor histopathology, and postoperative follow-up period between the Mild and Severe groups. At the final follow-up, 84.6% of IDEMSCTs patients were able to walk without support. Gait disturbance improved after surgery in most of the patients with preoperative MMCS grades II-IV, but remained in approximately half of patients with preoperative MMCS grade V. Age at surgery was correlated with poor improvement in postoperative gait disturbance in the Severe group.

CONCLUSIONS

Regardless of the degree of preoperative gait disturbance, it improved after tumor resection in most of the IDEMSCTs patients. However, in the preoperative MMCS grade III-V cases, older age at surgery would be an important factor associated with poor improvement in postoperative gait disturbance.

摘要

研究设计

回顾性比较研究。

目的

本研究旨在确定在患有硬脊膜外脊髓肿瘤(IDEMSCT)的患者中,手术切除后术前步态障碍的程度是否仍然存在,并探讨可能影响术后步态障碍改善不良的任何因素。

设置

日本的单一机构。

方法

共纳入 2010 年至 2019 年间需要手术切除的 78 例 IDEMSCT 患者。根据改良 McCormick 量表(MMCS)分级的术前步态障碍程度,将他们分为轻度和重度两组。平均术后随访时间为 50.7±17.9 个月。比较两组之间的人口统计学和手术特征数据。

结果

在手术时的年龄、性别、肿瘤大小、手术时间、估计失血量、肿瘤组织病理学和术后随访期方面,两组之间没有显著差异。在最终随访时,84.6%的 IDEMSCT 患者能够无支撑行走。术前 MMCS 分级 II-IV 的大多数患者术后步态障碍得到改善,但术前 MMCS 分级 V 的患者中约有一半仍存在步态障碍。手术时的年龄与重度组术后步态障碍改善不良相关。

结论

无论术前步态障碍程度如何,大多数 IDEMSCT 患者在肿瘤切除后都会得到改善。然而,在术前 MMCS 分级 III-V 病例中,手术时年龄较大是与术后步态障碍改善不良相关的重要因素。

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