目的 回顾性分析有脊髓压迫症状的胸椎血管瘤的两种手术效果,探讨哪种手术方式更值得推广.方法 收集郑州大学第一附属医院2008年1月至2012年2月收治的有脊髓压迫症状的胸椎血管瘤患者21例,根据手术方式分为A、B两组:A组10例采用360.全椎体切除+椎体重建植骨融合椎弓根螺钉内固定术;B组11例采用经椎弓根骨水泥注入术+椎管减压椎弓根螺钉内固定术,术后均行常规放疗.随访6~18个月,平均(10.0±2.3)个月,根据治疗前后及随访期间患者的临床表现,以疼痛视觉模拟评分(VAS)和日本骨科协会(JOA)评分,评定两组患者术后疼痛缓解及神经功能恢复情况,进行统计学分析.结果 21例患者神经症状均大部分缓解.术中出血量B组[(910±50)ml]明显少于A组[(1450±30)ml],P<0.05;术后第3天、6个月及末次随访时A、B两组VAS及JOA评分均较术前明显改善(P<0.05);术后第3天,B组两项评分(JOA 10.2 ±2.5、VAS 3.8 ±0.8)明显优于A组(JOA 7.8 ±1.9、VAS 5.1±1.0),P<0.05;6个月及末次随访时A、B两组间比较差异无统计学意义(P>0.05).结论 经椎弓根骨水泥注入术+椎管减压椎弓根螺钉内固定术治疗,患者术后恢复快,出血量明显减少,长期疗效好,是一种更好的手术方法.
Objective To investigate which kind of surgery treatment is more worth promoting by reviewing the outcomes of two different surgical treatment about thoracic vertebral hemangioma with extraosseous extension causing spinal cord compression.Methods From Jan.2008 to Feb.2012,we investigated the two different surgical treatment of 21 cases of thoracic vertebral hemangioma(TVH) having spinal cord compression,which were divided into two groups (group A and group B).Group A:10 cases of patients with extraosseous extension and spinal cord compression were operated on through anterior approach to resect the involved vertebral body and intracanal angioma,and bone graft and internal fixation were also completed in one-stage; Group B:11 cases with bone cement injection,spinal decompression and internal fixation.Patients were followed up for 6 to 18 months,with an average of(10.0 ± 2.3) months.The recovery of neurological function and the pain relief were measured by visual analogue scale (VAS) score and Japanese orthopaedic association (JOA) score.Results In all 21 cases with neural lesion symptoms received open surgery with neurological symptoms partially regained.All patients of two groups were followed up.The blood loss during operation in group A was(1450 ±30) ml,the blood loss during operation in group B was(910 ±50) ml.The JOA score and VAS score had a significant recovery at 3 days,6 months and at last follow-up when compared with preoperative values (P < 0.05); The difference between group A and group B was statistically significant at 3 days after surgery(P <0.05) ;The score of JOA and VAS of group B(JOA 10.2 ±2.5 and VAS 3.8 ±0.8) was significantly better than that of group A(JOA 7.8 ± 1.9 and VAS 5.1 ± 1.0) ; But there was no significant difference between the two groups in statistics at 6 months and at last follow-up(P > 0.05).Conclusions The surgical treatment of bone cement injected by the pedicle,spinal decompression and pedicle screw fixation,is a better surgical techniques,because the patients' postoperative recovery is quick,and complications is significantly reduced.