复合手术治疗硬脊膜动静脉瘘的疗效及其影响因素分析
Analysis of the efficacy and influencing factors of hybrid surgery in the treatment of spinal dural arteriovenous fistula
胡晓珺 1刁宇航 1谭睿 1郝正浩 1郝明钰 1谢明浩 1戎宏涛 1朱涛1
作者信息
- 1. 天津医科大学总医院神经外科,天津 300000
- 折叠
摘要
目的 观察复合手术治疗硬脊膜动静脉瘘(SDAVF)的疗效,并探讨影响患者预后的相关因素.方法 回顾性分析2018年1月至2022年1月天津医科大学总医院神经外科收治的76例SDAVF患者的临床资料.患者均行复合手术切断SDAVF引流血管.采用MRI观察脊髓水肿节段、水肿横截面积比值、水肿长径和短径的变化情况;采用改良Aminoff-Logue评分(mALS)评估脊髓神经功能情况,包括mALS总分、下肢运动功能评分及排尿和排便功能评分;术后12个月mALS总分较术前降低≥2分为改善,降低＜2分为无明显改善.分析不同预后患者临床资料的差异,采用多因素logistic回归分析法分析影响患者预后的相关因素.结果 76例患者术后的随访时间[M(Q1,Q3)]为15.0(13.5,20.0)个月.脊髓MRI显示,术后所有患者脊髓水肿及迂曲血管影均改善,无一例复发.术后12个月,76例患者中,mALS改善33例(43.4％),无明显改善43例(56.6％).与无明显改善组比较,改善组患者的病程短、术前mALS总分和步态评分低、术前水肿节段数少,差异均有统计学意义(均P＜0.05).而年龄、性别、瘘口部位,术前排尿、排便功能评分,以及脊髓水肿的长径、短径、横截面积比值的差异均无统计学意义(均P＞0.05).多因素logistic回归分析显示,病程短(OR=0.92,95％CI:0.86～0.99,P=0.028)、术前的 mALS 总分低(OR=0.76,95％CI:0.59～0.99,P=0.043)和脊髓水肿的节段数少(OR=0.78,95％CI:0.62～0.98,P=0.035)与患者的预后良好相关(均P＜0.05).结论 复合手术治疗SDAVF,术后脊髓神经功能恢复较好.病程短、术前的mALS低及脊髓水肿的节段数少是患者预后良好的重要影响因素.
Abstract
Objective To observe the efficacy of hybrid surgery in the treatment of spinal dural arteriovenous fistula(SDAVF),and to explore the related factors affecting patient prognosis.Methods The clinical data of 76 SDAVF patients admitted to the Neurosurgery Department of Tianjin Medical University General Hospital from January 2018 to January 2022 were retrospectively analyzed.All patients underwent hybrid surgery to cut off the SDAVF drainage vessels.MRI was used to observe the changes in spinal cord edema segments,edema cross-sectional area ratio,and major and minor diameters of edema;modified Aminoff and Logue score(mALS)was used to evaluate spinal cord neurological function,including thALS total score,lower limb motor function score and urination.and defecätion function score;a decrease of≥2 in the total mALS score 12 months after surgery compared to preoperative was considered improvement,a decrease of＜2 was considered no significant improvement,and an increase of≥2 was considered worsening.The differences in clinical data of patients with different outcomes were analyzed,and multivariate logistic regression analysis was used to analyze the related factors affecting patient outcomes.Results The postoperative follow-up time[M(Q1,Q3)]of 76 patients was 15.0(13.5,20.0)months.MRI showed that spinal cord edema and tortuous vascular shadows improved in all patients after surgery,and no case recurred.Twelve months after surgery,among 76 patients,mALS improved in 33 patients(43.4％)and had no significant improvement in 43 patients(56.6％).Compared with the group without significant improvement,the patients in the improvement group had shorter disease duration,lower preoperative mALS total score and gait score,and fewer preoperative edema segments,and the differences were statistically significant(all P＜0.05).However,there were no statistically significant differences in age,gender,fistula location,preoperative urinary and defecation function scores,or the ratio of major diameter,minor diameter,and cross-sectional area of spinal cord edema(all P＞0.05).Multivariate logistic regression analysis showed that short disease duration(OR=0.92,95％CI:0.86-0.99,P=0.028)and low preoperative mALS total score(OR=0.76,95％CI:0.59-0.99,P=0.043)and a small number of spinal cord edema segments(OR=0.78,95％CI:0.62-0.98,P=0.035)were related to good outcome of the patient(all P＜0.05).Conclusions After hybrid surgery for SDAVF,spinal cord neurological function recovers better after surgery.Short course of disease,low preoperative mALS and few spinal cord edema segments are important factors influencing the patient's good prognosis.
关键词
脊髓血管疾病/动静脉瘘/治疗结果/影响因素分析/复合手术Key words
Spinal cord vascular diseases/Arteriovenous fistula/Treatment outcome/Root cause analysis/Hybrid operation引用本文复制引用
出版年
2024
NETL
NSTL
万方数据