| Objective:To explore the clinical value of minimally invasive expandable channel in the treatment of intraspinal schwannoma by comparing the efficacy and safety of minimally invasive expandable channel and traditional operation in the treatment of intraspinal schwannoma.Methods:The clinical data of patients with intraspinal schwannoma treated in the Department of Neurosurgery of the affiliated Hospital of Guizhou Medical University from January 2016 to April 2021 were retrospectively analyzed.A total of 75 patients who met the inclusion criteria and completed 12-month follow-up were divided into minimally invasive channel group,total laminectomy group,semi-laminectomy group,laminectomy group and nail-rod system internal fixation group.15 patients in each group were followed up for 1 day,1 month,6 months and 12 months after operation.The clinical data of each group were compared,including sex,age,intraoperative blood loss,operation time,incision length,operative complications,postoperative recurrence,preoperative and postoperative VAS pain score,JOA score and imaging data.All data were statistically analyzed by SPSS22.0.If the samples were in accordance with normal distribution,independent sample t-test and independent sample rank sum test were used for non-normality.Chi-square test was used for counting data.Results:A total of 75 patients were included in this study,and all of them completed the operation successfully.1.The results showed that the average operation time of minimally invasive channel group was 1.5 hours,while that of traditional open operation group was about 3.0h,P < 0.001.The intraoperative blood loss was about30 ml in minimally invasive channel group and 180 ml in traditional open operation group(P < 0.001).The length of incision was about 2.9cm in the minimally invasive group and 7.6cm in the traditional group(P < 0.001),and the length of hospital stay was about 15 days in the minimally invasive group and 22 days in the traditional open group(P < 0.001).The hospitalization cost of minimally invasive channel group was about 65000 yuan,and that of traditional open surgery group was about 85000 yuan,the difference was statistically significant(P < 0.001).There was no significant difference in VAS preoperative score between the two groups(P < 0.001),but at 1day,1 month,6 months and 12 months after operation,the difference was statistically significant(P < 0.05).The results of JOA score showed that the P values before operation,1 day,1 month and 6 months after operation were 0.239,0.823,0.189 and0.360 respectively,and the difference was not statistically significant.two。.The comparison of minimally invasive channel and four traditional open surgical methods showed that the minimally invasive channel group had the shortest operation time,about 1.5 hours.The total laminectomy,laminectomy,nail-rod system surgery and semi-laminectomy group were 3.0 hours,3.5 hours,4.0 hours and 2.5 hours respectively,and the difference was statistically significant.The amount of bleeding in the minimally invasive group was the least,about 37.67 ±26.18 ml.The amount of blood loss in the other four traditional open groups was significantly higher than that in the minimally invasive group,and the difference was statistically significant.The length of incision in minimally invasive approach group was the shortest,about 2.9cm,and the length of total laminectomy,laminectomy,nail-rod system operation and semi-laminectomy were 7.5 cm,7.7 cm,7.8 cm and 7.5 cm,respectively,and the difference was statistically significant.The hospital stay of patients treated with minimally invasive approach was the shortest,about 15.27 ±2.92 days,which was significantly shorter than that of the other four traditional open procedures.In terms of hospitalization costs,we found that minimally invasive passage surgery was significantly less than lamina reduction and nail-rod system surgery.3.This study made a statistical analysis of the complications after various surgical procedures:there was 1 case of postoperative infection in the minimally invasive channel group,accounting for about 6.7% of the minimally invasive channel group.Wound infection occurred in 1 case(6.7%)in the total laminectomy group,spinal instability in 2 cases(13.3%)in the total laminectomy group,and cerebrospinal fluid leakage in 1 case after semi-laminectomy and nail-rod system surgery,accounting for about 6.7%.Chi-square test showed that although there was no statistical significance among the various postoperative complications.4.According to the statistical analysis of tumor recurrence after various surgical methods,it was found that there was 1 case of recurrence after lamina reduction,accounting for about 6.7% of the group.There was no recurrence in the other four groups.Chi-square test found that,but there was no statistical difference.Conclusions:Minimally invasive expandable channel is a minimally invasive,safe and efficient method for the treatment of intraspinal schwannoma with 2 vertebral segments,maximum diameter ≤ 2cm,maximum extraforaminal diameter ≤ 1cm,and spinal stability is not affected.At the same time,small incision,less bleeding,short postoperative hospital stay,low hospitalization cost,and does not increase the incidence of postoperative complications,has a good clinical application value. |
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