硬脊膜动静脉瘘治疗的临床结果和预后:一项 12年单中心回顾性研究

Clinical Outcomes and Prognostic Factors for Spinal Dural Arteriovenous Fistula Treatment: a 12 years monocentric experience

摘要:

目的：探讨单中心对硬脊膜动静脉瘘患者进行治疗后的临床转归及影响预后的相关因素。 方法：回顾性分析2013年6月至2023年7月期间收治的脊髓血管性疾病的患者的临床资料。收集人口统计学信息、症状持续时间、术前及术后改良Aminoff-Logue量表（mALS）评分、巴宾斯基征、影像学表现等数据。采用χ2检验、Logistic回归模型进行统计分析。 结果：共纳入110例患者，其中男性占87.3%，平均年龄59.3岁。平均随访时间为87.6（±31.9）个月。末次随访时，76.4%的患者mALS评分有所改善。多因素分析显示，年龄增长与预后不良显著相关（OR=0.88，P<0.001）；而术前较高的mALS评分（P=0.048）、瘘口位于腰骶段（OR=12.62，P =0.031）、术后水肿快速消退（P =0.026）均具有统计学意义。此外，巴宾斯基征阴性的患者排便功能恢复可能性更高（OR=5.67，P =0.040）。 结论：手术闭塞瘘口是治疗SDAVF的有效方法，可显著改善患者的神经功能。其中，患者的年龄、术前神经功能状态、巴宾斯基征阴性、瘘口位置及术后脊髓水肿变化情况是预后的重要预测因素。

Abstract:

Abstract Objective: The purpose of the study was to investigate the clinical outcomes and prognostic factors in patients with treated SDAVFs in a single center to support clinical therapeutic decisions and prognostic evaluation. Methods: A retrospective analysis was conducted on the clinical data from patients with spinal vascular malformations admitted at a single center from June 2013 to July 2023. Inclusion criteria were as follows: (1) diagnosis confirmed by spinal digital subtraction angiography (DSA); (2) preoperative magnetic resonance imaging (MRI) examination; (3) a minimum postoperative follow-up period of one year. Data collected included demographic information, symptom duration, preoperative and postoperative modified Aminoff-Logue Scale (mALS) scores, Babinski sign status, and imaging findings. Statistical analyses were performed using χ2tests and multivariate logistic regression models. Results: Among 110 patients, 87.3% were male, with an average age of 59.3 years. The mean follow-up duration was 87.6 (±31.9) months. At the last follow-up, 76.4% of patients showed improvement in mALS scores. Multivariate analysis revealed that older age (OR=0.88,P<0.001) was significantly associated with poor prognosis, whereas higher preoperative mALS scores (P=0.048), fistula located in the lumbosacral region (OR=12.62, P=0.031), and rapid resolution of postoperative edema (P=0.026) were related to functional improvement. Patients with a negative Babinski sign had a higher likelihood of recovering bowel function (OR=5.67, P=0.040). Conclusion: Surgical occlusion of the fistula is an effective treatment for SDAVF, capable of significantly improving neurological function. Age, preoperative neurological status, a negative Babinski sign, fistula location and early postoperative changes in spinal cord edema are important predictors of prognosis. Keywords Spinal dural arteriovenous fistula · Surgery· prognostic · Babinski sign