| Objective To evaluate the efficacy of microsurgical treatment of intramedullary spinal cord tumors,and analyze the correlation factors influencing the postoperative neurological function.Materials and methods We retrospectively analyed 38 cases of intramedullary spinal cord tumor patients who were treated by microsurgical in the Department of Neurosurgery of The First Affiliated Hospital of Dalian Medical University from April2005 to April 2015.We used the McMcormick grading system to evaluate the neurological status of the patients.By comparing the clinical symptoms and state of neurological function before and after operation,the therapeutic effect of the microsurgery treatment of intramedullary spinal cord tumors was evaluated.Using correlation analysis,principal component analysis and multivariate binary logistic regression,analyzed and compared age,gender,nature of the tumor,location of tumor,tumor resection range and preoperative neurological status on neurologic improvement in the situation after surgery.Result1.Comparison of the clinical symptoms of patients before and after surgery.After microsurgical treatment,the number of cases of patients with limb numbness,pain,movement disorders,sphincter dysfunction were significantly impro-ved in 16 cases,12 cases,12 cases and 3 cases.Patients with limb numbness(χ2=14.098,P=0.000),dyskinesia(χ2=7.6,P=0.006),pain(χ2=8.769,P=0.003)were better than preoperative,there was statistically significant difference.Sphincter function after operation(χ2=0.856,P=0.355)had no significant difference compared with the preoperative.2.Comparison of neurological function in patients before and after operationIn these 38 cases,there were 7 cases of preoperative neurological grade I and 31 cases of grade II + III + IV before operation,and after operation,there were 26 cases of preoperative neurological grade I and 12 cases of grade II + III + IV.The number of patients of level I after operation was significantly increased compared with that before operation(χ2=19.34,P<0.001).3.Comparison and analysis of correlation factors influencing the postoperative neurological function.Postoperatively,neurological function was improved in 28 cases,not improved in10 cases.Using the correlation analysis,principal component analysis and multivariate binary logistic regression analysis,we got the marginal effects of the tumor resection degree,nature of the tumor,preoperative neural function,tumor location,age and sex of patients on the improvement of neurological function after surgery were 57.64%,46.73%,45.66%,22.30%,9.21%,9.04%,respectively.4.Prognosis and recurrence of tumor3 patients(7.9%)died during follow-up,Of the 35 cases of follow-up,9 cases(25.7%)returned to normal work,16 cases(45.7%)can take care of themselves,6 cases(17.1%)can be partly self care,4 cases(11.4%)can not take care of themselves completely.In 38 cases,tumor recurrence occurred in 8 cases(21%),and the mean recurrence time was 38.4 months.Conclusion1.Microsurgical treatment of intramedullary spinal cord tumors can significantly improve the neurological function and clinical symptoms of patients,and the postoperative quality of life was significantly improved.2.The factors which mostly influenced the improvement of the nerve function after operation were the degree of resection,the nature of the tumor and the preoperative neural function.Patients with batter preoperative neurological function or larger range of tumor resection,the postoperative neurological function improved more obviously.3.The location of the tumor in the spinal cord had week effect on the postoperative neurological function.The effect of age and sex on the neurological function of patients was negligible.4.The prognosis of intramedullary tumors was different,most of the patients were able to take care of themselves,and the quality of life was significantly improved.But there were still a few patients with poor quality of life. |
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