北京大学学报(医学版) ›› 2019, Vol. 51 ›› Issue (5): 840-850. doi: 10.19723/j.issn.1671-167X.2019.05.009

• 论著 • 上一篇    下一篇

少节段和多节段髓内肿瘤的临床对照

孙建军1,(),杨军1,谢京城1,常青2,马长城1,郑梅3,LIAO Hung-I4,王涛1,陈晓东1,韩芸峰1,林国中1,于涛1,张嘉1,司雨1   

  1. 1. 北京大学第三医院 神经外科, 北京 100191
    2. 北京大学第三医院 病理科, 北京 100191
    3. 北京大学第三医院 神经科, 北京 100191
    4. Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237
  • 收稿日期:2018-01-27 出版日期:2019-10-18 发布日期:2019-10-23
  • 通讯作者: 孙建军 E-mail:15611963113@163.com
  • 基金资助:
    国家自然科学基金(81200969/H0912);教育部新教师基金(200800011035)

Comparative clinical study on seldom segment with multiple segment intramedullary primary spinal cord tumors

Jian-jun SUN1,(),Jun YANG1,Jing-cheng XIE1,Qing CHANG2,Chang-cheng MA1,Mei ZHENG3,Hung-I LIAO4,Tao WANG1,Xiao-dong CHEN1,Yun-feng HAN1,Guo-zhong LIN1,Tao YU1,Jia ZHANG1,Yu SI1   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
    4. Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
  • Received:2018-01-27 Online:2019-10-18 Published:2019-10-23
  • Contact: Jian-jun SUN E-mail:15611963113@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81200969/H0912);the Grants from Science Foundation for the Excellent Youth Scholars of Ministry of Education of China(200800011035)

摘要:

目的:对比性分析少节段和多节段髓内原发性肿瘤患者神经功能和预后的差异。方法: 选择北京大学第三医院2010年1月至 2015年12月显微神经外科手术治疗髓内肿瘤患者进行回顾性分析,共收集病例135例,用IJOA(improved Japanese orthopaedic association) 评分评估手术前后的神经功能状况。结果: 在少节段和多节段髓内肿瘤患者中,术前IJOA评分(P=0.02)和术后早期IJOA评分(P=0.004)差异均有统计学意义,不论术前还是术后早期,少节段髓内肿瘤患者神经功能都较好一些,大部分多节段髓内肿瘤患者都有不同程度的肢体无力,但是,对于术后长期的神经功能,多节段和少节段髓内肿瘤患者的差异无统计学意义(P=0.12),经过积极的功能锻炼,多节段髓内肿瘤患者的神经功能状况得以充分改善。结论:相比多节段髓内原发肿瘤患者,少节段髓内原发肿瘤患者围手术期的神经功能状况要好一些,尤其在肢体肌力方面,经积极功能锻炼,多节段髓内肿瘤患者的远期神经功能状况得以充分改善。

关键词: 髓内原发肿瘤, 少节段, 多节段, 病理, 神经功能, 预后

Abstract:

Objective: Several clinical studies were performed on multi-segment intramedullary primary spinal cord tumors. However, no clinical study focused on the relationship between different vertebral segments intramedullary tumors involvement and neurological functions, as well as prognosis of the patients. This prospective study was performed to compare clinical analysis on neurological functions and prognosis of the patients with intramedullary spinal cord primary tumors. Methods: A prospective cohort study was performed in a single medical center, Neurosurgical Department, Peking University Third Hospital. Between Jan. 1, 2010 and Dec. 30, 2015, 135 patients underwent microsurgery for intramedullary primary spinal cord tumors. The intramedullary tumor length occupying 3 or more vertebral body levels was considered as multiple segments intramedullary primary spinal cord tumor, and occupying one or two vertebral body levels considered as seldom segments. Preoperative and postoperative functions were assessed using IJOA (improved Japanese orthopaedic association) scoring system, and analyzed using the appropriate statistical tests. Results: Among the 135 patients, 52 cases had seldom segments intramedullary primary spinal cord tumors, and 83 cases had multiple segments. In the seldom group, 32 (62%) patients presented with normal urine and stool function, 8 (15%) patients with severe dysfunction, 7 (14%) with slight dysfunction, and 5 (9%) with incontinence, and 30 (58%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 16.9±2.4. The postoperative IJOA scores at the end of 3 months were 16.6±2.3. The current IJOA scores until the end of the follow-up were 17.5±4.4. In the multiple group, 37 (45%) patients presented with normal urine and stool functions, 26 (31%) patients with slight dysfunction, 11 (13%) with severe dysfunction, and 9 (11%) with incontinence, and 62 (75%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 15.6±3.4. The postoperative IJOA scores at the end of 3 months were 15.5±3.8. The current IJOA scores until the end of the follow-up were 16.9±5.8. The difference of presenting urine and stool dysfunction (Z=-1.35, P=0.18) was not statistically significant between the different patient groups. However, the difference of presenting limbs weakness (Z=-2.06, P=0.04) was statistically significant between the two groups. Most patients with multiple segment intramedullary tumors suffered from various limbs weakness. The difference of the preoperative IJOA score (P=0.02) and the postoperative early IJOA score (P=0.004) of the patients was statistically significant between the seldom and multiple segments groups. Preoperative and early postoperative neurological function of the patients was better with seldom segments tumor than with multiple segments tumor. Most patients with multi-segment intramedullary tumors experienced various limbs weakness. However, the difference of long-term neurological function (P=0.12) between the seldom and multiple segments groups was not statistically significant. The neurological function of the patients with multiple segments intramedullary tumor was remarkably improved after physical therapy. Conclusion: Perioperative neurological function of the patients with seldom segments primary tumor was superior to that of the patients with multiple segments primary tumor, especially for limb strength. The neurological function of the patients with multiple segments intramedullary primary tumor was remarkably improved after physical therapy during long-term follow-up.

Key words: Intramedullary primary tumor, Seldom segments, Multiple segments, Pathology, Neurological functions, Prognosis

中图分类号: 

  • R739.42

Table 1

The parameters of intramedullary primary spinal cord tumors in different segment groups (x?±s)"

Items Different groups All patients t value P value
Seldom Multiple
Age/years 40±15 40±14 40±14 0.31 0.76
Occupied numbers 1.8±0.4 4.2±1.8 3.3±1.8 34.3 <0.001
Hospitalization time/d 16.4±2.5 17.9±6.2 16.5±4.8 -1.22 0.23
Duration of symptoms/months 22±29 47±77 37±64 11.9 0.001
Preoperative IJOA scores 16.9±2.4 15.6±3.5 16.1±3.2 6.13 0.02
Three months postoperative IJOA scores 16.6±2.4 15.5±3.8 15.9±3.4 8.53 0.004
Current IJOA scores 17.5±4.5 16.9±5.9 17.1±5.3 2.38 0.12
Longer meter of tumors/cm 2.8±1.6 8.3±5.07 6.2±4.9 11.1 0.001
Follow-up period/months 42±17 40±21 43±19
Case numbers 52 83 135

Table 2

The nonparameters of intramedullary primary spinal cord tumors in different segment groups"

Items Different groups All patients Z value P value
Seldom Multiple
Gender -0.15 0.88
Male 27 (52%) 42 (51%) 69 (51%)
Female 25 (48%) 41 (49%) 66 (49%)
Presenting symptoms -1.04 0.30
Pain 18 (35%) 35 (42%) 53 (39%)
Numbness 12 (23%) 18 (22%) 30 (22%)
Limbs weakness 10 (19%) 13 (16%) 23 (17%)
Neck or limbs discomfort 7 (13%) 3 (4%) 10 (8%)
Urine and/or stool dysfunction 3 (6%) 4 (5%) 7 (5.2%)
Numbness and weakness 2 (4%) 7 (8%) 9 (6.7%)
Dyspnea 0 1 (1%) 1 (0.7%)
Dizziness 0 1 (1%) 1 (0.7%)
Limbs malformation 0 1 (1%) 1 (0.7%)
Preoperative bowel/bladder -1.35 0.18
Normal 32 (62%) 37 (45%) 69 (51%)
Slight dysfunction 7 (14%) 26 (31%) 33 (25%)
Severe dysfunction 8 (15%) 11 (13%) 19 (14%)
Incontinent 5 (9%) 9 (11%) 14 (10%)
Preoperative motor weakness -2.06 0.04
Normal 22 (42%) 21 (25%) 43 (32%)
Weakness 30 (58%) 62 (75%) 92 (68%)
Location -1.57 0.12
Cervical 15 (29%) 30 (36%) 45 (33%)
Thoracic 17 (33%) 19 (23%) 36 (27%)
Cervicothoracic 2 (4%) 11 (13%) 13 (10%)
Thoracolumbar 6 (11%) 12 (15%) 18 (13%)
Lumbar 11 (21%) 9 (11%) 20 (15%)
Medulla-cervical 1 (2%) 2 (2%) 3 (2%)
Removal extent -1.72 0.09
Class Ⅰ 39 (75%) 52 (63%) 91 (67.4%)
Class Ⅱ 8 (15%) 14 (17%) 22 (16.3%)
Class Ⅲ 5 (10%) 11 (13%) 16 (11.9%)
Class Ⅳ 0 6 (7%) 6 (4.4%)
Histological pathology -3.12 <0.01
Vascular tumors 16 (31%) 0 16 (12%)
Ependymoma 14 (27%) 40 (48%) 54 (40%)
Teratoma 6 (11%) 15 (18%) 21 (16%)
Lipoma 0 7 (8%) 7 (5%)
Diffuse astrocytoma 5 (9%) 7 (8%) 12 (9%)
High-grade gliomas 4 (8%) 5 (6%) 9 (7%)
Cyst 4 (8%) 4 (5%) 8 (6%)
Low-grade gliomas 3 (6%) 3 (4%) 6 (4%)
Schwannoma 0 2 (3%) 2 (1%)

Table 3

Comparative analysis on the parameter of survived patients with dead patients"

Items Different groups F value P value
Survival Dead
Age/years 40.8±13.6 38.0±23.7 8.7 0.004
Hospitalization/d 15.9±3.1 23.6±14.1 35.0 <0.001
Preoperative IJOA scores 16.5±2.8 13.3±4.3 -3.1 0.003
Three months postoperative IJOA scores 16.5±3.0 12.9±5.1 9.0 0.003
Current IJOA scores 18.3±2.7 0 6.1 0.020
Case number 110 8

Table 4

Comparative analysis on the nonparameter of survived patients with dead patients"

Items Different groups All patients Z value P value
Survived Dead
Recurrence of tumors -5.37 <0.001
Yes 7 (6%) 6 (75%) 13 (11%)
No 103 (94%) 2 (25%) 105 (89%)
Removal extent -5.16 <0.001
Class Ⅰ 82 (75%) 1 (12.5%) 83 (70%)
Class Ⅱ 17 (15%) 1 (12.5%) 18 (15%)
Class Ⅲ 11 (10%) 4 (50%) 15 (13%)
Class Ⅳ 0 2 (25%) 2 (2%)
Histological pathology -4.63 <0.001
Ependymoma 50 (45%) 0 50 (42%)
Teratoma 20 (18%) 0 20 (17%)
Vascular tumor 13 (12%) 1 (12.5%) 14 (13%)
Diffuse astrocytoma 8 (7%) 2 (25%) 9 (8%)
High-grade gliomas 2 (2%) 4 (50%) 6 (5%)
Low-grade glioma 4 (4%) 1 (12.5%) 5 (4%)
Lipoma 6 (5.5%) 0 6 (5%)
Neuronoma 2 (2%) 0 2 (2%)
Cyst 5 (4.5%) 0 5 (4%)

Table 5

Affected parameter factors on recurrence and regrowth of intramedullary tumors"

Items Different groups t value P value
Recurrence or regrowth Locally controlled
Age/years 33.1±19.8 45.3±12.6 -2.68 0.009
Duration of symptoms /months 6.3±6.5 39.0±65.9 5.8 0.020
Hospitalization/ d 21.4±11.4 15.8±3.1 19.3 <0.001
Current IJOA scores 7.0±7.8 18.4±3.3 33.4 <0.001
Three months postoperative IJOA scores 12.7±4.9 16.7±2.8 19.4 <0.001
Case number 105 13

Table 6

Affected nonparameter factors on recurrence and regrowth of intramedullary tumors"

Items Different groups All patients Z value P value
Recurrence or regrowth Local control
Removal extent -5.64 <0.001
Class Ⅰ 1 (7%) 82 (78%) 83 (70%)
Class Ⅱ 4 (31%) 14 (13%) 18 (15%)
Class Ⅲ 6 (47%) 9 (9%) 15 (13%)
Class Ⅳ 2 (15%) 0 2 (2%)
Histological pathology -2.35 0.02
Ependymoma 2 (15%) 48 (45%) 50 (42%)
Teranoma 2 (15%) 18 (17%) 20 (17%)
Diffuse astrocytoma 3 (24%) 6 (6%) 9 (8%)
High-grade glioma 5 (39%) 2 (2%) 7 (6%)
Low-grade glioma 1 (7%) 4 (4%) 5 (4%)
Lipoma 0 6 (6%) 6 (5%)
Vascular tumors 0 14 (13%) 14 (12%)
Neuronoma 0 2 (2%) 2 (2%)
Cyst 0 5 (5%) 5 (4%)
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