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胸髓外脊柱肿瘤显微镜下全椎板切除术(开放手术)与微创小关节入路内镜下半椎板切除术的比较。

Comparison of microscopic full-laminectomy (open surgery) and microendoscopic minimally invasive hemilaminectomy for thoracic extramedullary spinal tumours.

机构信息

Department of Neurosurgery, Tongling People's Hospital, No.468, Tongling, 244099, Anhui, People's Republic of China.

出版信息

J Cardiothorac Surg. 2024 Jul 13;19(1):444. doi: 10.1186/s13019-024-02969-4.

Abstract

BACKGROUND

Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery).

METHODS

Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed.

RESULTS

In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393).

CONCLUSIONS

MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.

摘要

背景

脊髓肿瘤的微创治疗较为常见。本研究旨在比较经自制管状牵开器下微创显微镜半椎板切除术(MIS-TR)与显微镜全椎板切除术(开放手术)治疗胸髓外脊髓肿瘤(TEST)患者的围手术期结果。

方法

2016 年 2 月至 2021 年 2 月,纳入 51 例 TEST 患者。根据其临床资料,患者分为 MIS-TR 组(n=30)和开放手术组(n=21)并进行评估。

结果

两组的平均手术时间、围手术期 ASIA 评分变化和改良 Macnab 评分相当。MIS-TR 组的平均术后住院时间明显短于开放手术组(p<0.0001)。MIS-TR 组的平均出血量明显低于开放手术组(p=0.001)。MIS-TR 组的围手术期并发症发生率明显低于开放手术组(p<0.0001)。在 3 个月的随访中,两组的 Oswestry 残疾指数(ODI)评分改善无显著差异。然而,在 12 个月的随访中,MIS-TR 组的平均 ODI 明显低于开放手术组(p=0.023)。术后完全恢复的主要影响因素为术前 ASIA 评分(OR 7.848,P=0.002)、手术并发症(OR 0.017,P=0.008)和年龄(OR 0.974,P=0.393)。

结论

与开放手术相比,MIS-TR 治疗 TEST 更安全、更有效,但 MIS-TR 的长期恢复并不优于开放手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/49f3/11245853/fa2534eefbfd/13019_2024_2969_Fig1_HTML.jpg

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