椎板切除后椎板再植治疗椎管内肿瘤的预后影响因素分析
Analysis of Prognostic Factors Affecting the Treatment of Intraspinal Tumors after Laminectomy Followed by Laminar Reimplantation

介绍：椎管内肿瘤是脊柱外科的常见疾病。由于多数肿瘤是良性的，手术切除是治疗的有效手段，也是这些肿瘤的主要治疗方法。传统椎板切除术后需要椎弓根螺钉固定，此种手术方式虽然保持了脊柱的稳定性并降低了后凸的发生率，但有许多并发症。近年来，肿瘤切除术后椎板再植越来越受到临床医生的青睐，但此种手术方式的临床预后各有差异。本文就以此来探讨影响椎板切除后椎板再植术后临床预后的相关因素，来提高临床疗效，以获得更好的临床指导。材料和方法：本研究对2018年1月至2023年5月在我院脊柱外科进行椎板切除后椎板再植手术患者100例进行回顾性分析。根据术前、术后日本骨科协会(JOA)评分改善率(治疗后评分改善率 = [(治疗后评分 ？ 治疗前评分)/17(29) ？ 治疗前评分] × 100%)分为有效组和无效组(改善率为100%时为治愈，改善率大于60%为显效，25%~60%为有效，小于25%为无效；25%~100%为有效组，小于25%为无效组)。对两组的年龄、性别、身高、体重、吸烟饮酒状况、高血压病史、糖尿病病史、病程时长、肿瘤节段、肿瘤位置、肿瘤大小、肿瘤病理性质、手术时间、术中出血量、肿瘤切除情况、术中应用人工硬脊膜情况、术后激素应用情况、术后并发症、术前JOA评分等数据进行汇总、计算和比较，统计学方法是首先对所有指标采用单因素分析，再将单因素分析中有统计学意义的指标进行多因素Logistic回归分析。结果：1) 单因素分析显示患者的年龄、性别、身高、体重、吸烟饮酒状况、高血压病史、糖尿病病史、病程时长、肿瘤大小、手术时间、术中出血量、肿瘤切除情况、术中应用人工硬膜情况、术后激素应用情况、术后并发症结果无统计学意义，而肿瘤节段、肿瘤位置、肿瘤病理性质、术前JOA评分在两组间比较有统计学意义。2) 多因素分析显示肿瘤位置、肿瘤病理性质、术前JOA评分在两组间比较有统计学意义，而肿瘤节段在两组间比较无统计学意义。结论：经研究显示，肿瘤位置、肿瘤病理性质、术前JOA评分是椎管内肿瘤行椎板切除后椎板再植术后临床预后的独立危险因素。
Introduction: Intraspinal tumor is a common disease in spinal surgery. Since most tumors are be-nign, surgical resection is an effective means of treatment and the main treatment for these tumors. Traditional laminectomy requires pedicle screw fixation, which maintains spinal stability and re-duces the incidence of kyphosis, but has many complications. In recent years, laminectomy after tumor resection has become more and more popular among clinicians, but the clinical prognosis of this type of surgery is varied. In this paper, the relevant factors affecting the clinical prognosis after laminectomy and laminectomy were discussed in order to improve the clinical efficacy and obtain better clinical guidance. Materials and Methods: This study retrospectively analyzed 100 patients who underwent laminectomy and laminectomy after laminectomy in the Department of Spinal Surgery of our hospital from January 2018 to May 2023. According to the improvement rate of Jap-anese Orthopedic Association (JOA) before and after surgery (improvement rate after treatment = [(post-treatment score ？ pre-treatment score)/17(29) ？ pre-treatment score] × 100%), the effec-tive group and the ineffective group were divided into two groups (the improvement rate was 100% as cure, the improvement rate was greater than 60% as obvious effect, and 25%~60% as effective. Less than 25% is invalid; 25%~100% is valid group, less than 25% is invalid group). Age, sex, height, weight, smoking and drinking status, history of hypertension, history of diabetes, disease duration, tumor segment, tumor location, tumor size, tumor pathological nature, operation time, intraoperative blood loss, tumor resection, intraoperative application of