( ! ) Deprecated: 從 2.8.0 版開始,Elementor\Scheme_Typography <strong>已淘汰不用</strong>,請改用 Elementor\Core\Schemes\Typography。 in /var/www/vhosts/neurosurgeon.hk/httpdocs/wp-includes/functions.php on line 5401
Call Stack
#TimeMemoryFunctionLocation
10.0006364352{main}( ).../index.php:0
20.0010365704require( '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-blog-header.php ).../index.php:17
31.133373086064require_once( '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-includes/template-loader.php ).../wp-blog-header.php:19
41.160574024864apply_filters( $hook_name = 'template_include', $value = '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-content/themes/hello-elementor/index.php' ).../template-loader.php:104
51.160574025272WP_Hook->apply_filters( $value = '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-content/themes/hello-elementor/index.php', $args = [0 => '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-content/themes/hello-elementor/index.php'] ).../plugin.php:189
61.232777190952ElementorPro\Modules\ThemeBuilder\Classes\Locations_Manager->template_include( $template = '/var/www/vhosts/neurosurgeon.hk/httpdocs/wp-content/themes/hello-elementor/index.php' ).../class-wp-hook.php:303
71.235477220496Elementor\Core\Base\Base_Object->get_settings( $setting = 'page_template' ).../locations-manager.php:148
81.235477220496Elementor\Core\Base\Base_Object->ensure_settings( ).../base-object.php:40
91.235477220496Elementor\Controls_Stack->get_init_settings( ).../base-object.php:142
101.235477220496Elementor\Controls_Stack->get_data( $item = 'settings' ).../controls-stack.php:2049
111.235477220496Elementor\Controls_Stack->sanitize_settings( $settings = ['eael_ext_toc_title' => 'Table of Contents', 'background_background' => 'classic', '__globals__' => ['background_color' => 'globals/colors?id=0e03762'], 'preview_type' => 'single/page', 'preview_id' => '408'], $controls = ??? ).../controls-stack.php:1061
121.235477220496Elementor\Controls_Stack->get_controls( $control_id = ??? ).../controls-stack.php:2302
131.235477220496Elementor\Controls_Stack->get_stack( ).../controls-stack.php:286
141.235577220496Elementor\Controls_Stack->init_controls( ).../controls-stack.php:480
151.235577220536ElementorPro\Modules\ThemeBuilder\Documents\Single_Base->register_controls( ).../controls-stack.php:2215
161.235577220536ElementorPro\Modules\ThemeBuilder\Documents\Theme_Page_Document->register_controls( ).../single-base.php:93
171.235577220536ElementorPro\Modules\ThemeBuilder\Documents\Theme_Document->register_controls( ).../theme-page-document.php:33
181.235577220536Elementor\Core\Base\Document->register_controls( ).../theme-document.php:270
191.235877224192do_action( $hook_name = 'elementor/documents/register_controls', ...$arg = variadic(class ElementorPro\Modules\ThemeBuilder\Documents\Single_Page { private ${Elementor\Core\Base\Document}main_id = 231; private ${Elementor\Core\Base\Document}is_saving = FALSE; private ${Elementor\Core\Base\Document}elements_iteration_actions = []; protected $post = class WP_Post { public $ID = 231; public $post_author = '1'; public $post_date = '2021-02-28 11:11:44'; public $post_date_gmt = '2021-02-28 03:11:44'; public $post_content = 'Previous\n\t\t\t\t\t\t\tNext'; public $post_title = 'BaS Page'; public $post_excerpt = ''; public $post_status = 'publish'; public $comment_status = 'closed'; public $ping_status = 'closed'; public $post_password = ''; public $post_name = 'bas-page'; public $to_ping = ''; public $pinged = ''; public $post_modified = '2021-04-19 10:49:30'; public $post_modified_gmt = '2021-04-19 02:49:30'; public $post_content_filtered = ''; public $post_parent = 0; public $guid = 'https://neurosurgeon.hk/?post_type=elementor_library&#038;p=231'; public $menu_order = 0; public $post_type = 'elementor_library'; public $post_mime_type = ''; public $comment_count = '0'; public $filter = 'raw' }; private ${Elementor\Controls_Stack}id = 231; private ${Elementor\Controls_Stack}active_settings = NULL; private ${Elementor\Controls_Stack}parsed_active_settings = NULL; private ${Elementor\Controls_Stack}parsed_dynamic_settings = NULL; private ${Elementor\Controls_Stack}data = ['id' => 231, 'settings' => [...], 'post_id' => 231]; private ${Elementor\Controls_Stack}config = NULL; private ${Elementor\Controls_Stack}current_section = ['tab' => 'style', 'condition' => [...], 'section' => 'eael_ext_table_of_content_header_style']; private ${Elementor\Controls_Stack}current_tab = NULL; private ${Elementor\Controls_Stack}current_popover = NULL; private ${Elementor\Controls_Stack}injection_point = NULL; private ${Elementor\Controls_Stack}settings_sanitized = FALSE; private ${Elementor\Controls_Stack}render_attributes = []; private ${Elementor\Core\Base\Base_Object}settings = NULL }) ).../document.php:585
201.235977224568WP_Hook->do_action( $args = [0 => class ElementorPro\Modules\ThemeBuilder\Documents\Single_Page { private ${Elementor\Core\Base\Document}main_id = 231; private ${Elementor\Core\Base\Document}is_saving = FALSE; private ${Elementor\Core\Base\Document}elements_iteration_actions = [...]; protected $post = class WP_Post { ... }; private ${Elementor\Controls_Stack}id = 231; private ${Elementor\Controls_Stack}active_settings = NULL; private ${Elementor\Controls_Stack}parsed_active_settings = NULL; private ${Elementor\Controls_Stack}parsed_dynamic_settings = NULL; private ${Elementor\Controls_Stack}data = [...]; private ${Elementor\Controls_Stack}config = NULL; private ${Elementor\Controls_Stack}current_section = [...]; private ${Elementor\Controls_Stack}current_tab = NULL; private ${Elementor\Controls_Stack}current_popover = NULL; private ${Elementor\Controls_Stack}injection_point = NULL; private ${Elementor\Controls_Stack}settings_sanitized = FALSE; private ${Elementor\Controls_Stack}render_attributes = [...]; private ${Elementor\Core\Base\Base_Object}settings = NULL }] ).../plugin.php:470
211.235977224568WP_Hook->apply_filters( $value = '', $args = [0 => class ElementorPro\Modules\ThemeBuilder\Documents\Single_Page { private ${Elementor\Core\Base\Document}main_id = 231; private ${Elementor\Core\Base\Document}is_saving = FALSE; private ${Elementor\Core\Base\Document}elements_iteration_actions = [...]; protected $post = class WP_Post { ... }; private ${Elementor\Controls_Stack}id = 231; private ${Elementor\Controls_Stack}active_settings = NULL; private ${Elementor\Controls_Stack}parsed_active_settings = NULL; private ${Elementor\Controls_Stack}parsed_dynamic_settings = NULL; private ${Elementor\Controls_Stack}data = [...]; private ${Elementor\Controls_Stack}config = NULL; private ${Elementor\Controls_Stack}current_section = [...]; private ${Elementor\Controls_Stack}current_tab = NULL; private ${Elementor\Controls_Stack}current_popover = NULL; private ${Elementor\Controls_Stack}injection_point = NULL; private ${Elementor\Controls_Stack}settings_sanitized = FALSE; private ${Elementor\Controls_Stack}render_attributes = [...]; private ${Elementor\Core\Base\Base_Object}settings = NULL }] ).../class-wp-hook.php:327
221.238377360472Essential_Addons_Elementor\Extensions\Table_of_Content->register_controls( $element = class ElementorPro\Modules\ThemeBuilder\Documents\Single_Page { private ${Elementor\Core\Base\Document}main_id = 231; private ${Elementor\Core\Base\Document}is_saving = FALSE; private ${Elementor\Core\Base\Document}elements_iteration_actions = []; protected $post = class WP_Post { public $ID = 231; public $post_author = '1'; public $post_date = '2021-02-28 11:11:44'; public $post_date_gmt = '2021-02-28 03:11:44'; public $post_content = 'Previous\n\t\t\t\t\t\t\tNext'; public $post_title = 'BaS Page'; public $post_excerpt = ''; public $post_status = 'publish'; public $comment_status = 'closed'; public $ping_status = 'closed'; public $post_password = ''; public $post_name = 'bas-page'; public $to_ping = ''; public $pinged = ''; public $post_modified = '2021-04-19 10:49:30'; public $post_modified_gmt = '2021-04-19 02:49:30'; public $post_content_filtered = ''; public $post_parent = 0; public $guid = 'https://neurosurgeon.hk/?post_type=elementor_library&#038;p=231'; public $menu_order = 0; public $post_type = 'elementor_library'; public $post_mime_type = ''; public $comment_count = '0'; public $filter = 'raw' }; private ${Elementor\Controls_Stack}id = 231; private ${Elementor\Controls_Stack}active_settings = NULL; private ${Elementor\Controls_Stack}parsed_active_settings = NULL; private ${Elementor\Controls_Stack}parsed_dynamic_settings = NULL; private ${Elementor\Controls_Stack}data = ['id' => 231, 'settings' => [...], 'post_id' => 231]; private ${Elementor\Controls_Stack}config = NULL; private ${Elementor\Controls_Stack}current_section = ['tab' => 'style', 'condition' => [...], 'section' => 'eael_ext_table_of_content_header_style']; private ${Elementor\Controls_Stack}current_tab = NULL; private ${Elementor\Controls_Stack}current_popover = NULL; private ${Elementor\Controls_Stack}injection_point = NULL; private ${Elementor\Controls_Stack}settings_sanitized = FALSE; private ${Elementor\Controls_Stack}render_attributes = []; private ${Elementor\Core\Base\Base_Object}settings = NULL } ).../class-wp-hook.php:303
231.239877406592spl_autoload_call( $class_name = 'Elementor\\Scheme_Typography' ).../Table_of_Content.php:594
241.239877406688Elementor\Autoloader::autoload( $class = 'Elementor\\Scheme_Typography' ).../Table_of_Content.php:594
251.239877406808Elementor\Utils::handle_deprecation( $item = 'Elementor\\Scheme_Typography', $version = '2.8.0', $replacement = 'Elementor\\Core\\Schemes\\Typography' ).../autoloader.php:336
261.239977407688_deprecated_file( $file = 'Elementor\\Scheme_Typography', $version = '2.8.0', $replacement = 'Elementor\\Core\\Schemes\\Typography', $message = ??? ).../utils.php:569
271.239977408008trigger_error( $message = '從 2.8.0 版開始,Elementor\\Scheme_Typography <strong>已淘汰不用</strong>,請改用 Elementor\\Core\\Schemes\\Typography。', $error_type = 16384 ).../functions.php:5401
脊椎內腫瘤 – 香港微創腦及脊椎神經外科手術中心

脊椎的構造

脊椎是支撐人體軀幹的大樑。頸椎承接著頭顱,經過胸椎、腰椎、薦椎而連接到骨盤。

脊髓( spinal cord )是神經系統中重要的一部分。在顱頸的交會處,脊髓向上承接腦幹後,便被嚴密的保護在脊椎的神經腔中,由頸部一直延申到腰椎;右圖即是脊髓在脊椎內分佈情形。

並且在每一節的脊椎孔,脊髓都會分派出一對脊椎神經與軀幹或肢體相連,把軀幹四肢的感覺訊號上傳至大腦的神經中樞,同時也將中樞神經所下達的指令傳達至四肢軀幹。一但脊髓受損,如果損傷的部位在第 5 節頸椎以上,病人將因呼吸衰竭而死亡。如果損傷的部位在第 5 、 6 、 7 節頸椎,將會造成病人四肢癱瘓。胸椎以下的脊髓損傷,也將造成病人下肢麻木癱瘓、大小便失控。

正因為脊髓在人體的功能上扮演如此重要的角色,病人一但被診斷出有脊椎內腫瘤,便以為罹患了不治之症,然而事實並非如此。

脊髓的外側有一層硬膜( dura )包覆,硬膜之內充滿了腦脊髓液。脊髓本身即有一層軟膜包著。

脊椎內腫瘤

脊椎內原發性腫瘤依生長的部位不同,大致可分為三類:

第一類是生長於脊髓硬膜外( epidural )的腫瘤,最常見的是脊椎轉移癌,除了可能直接壓迫脊髓之外,也可能破壞脊椎體而造成病理性骨折。

第二類是生長在於硬膜內但是在脊髓軟膜外( extramedullary )的腫瘤,多半是良性瘤,最常見的是神經鞘瘤( schwannoma )及硬膜瘤( meningioma ),一般而言可經手術安全切除而不對神經功能造成任何影響。

第三類是生長於脊髓內( intramedullary )的腫瘤,最常見的是室管膜瘤( ependymoma )、星狀細胞瘤 (astrocytoma) ,也可經由手術徹底的切除。

 

血管母細胞瘤也是脊髓內腫瘤的一種,因腫瘤周遭血管密佈,手術難度尤其高;其病因不明,但根據經驗,半數病人伴有 Von Hippel-Lindau 症候群的家族史,目前正針對患者的 DNA 異常進行研究,未來或許能找出是否基因出了問題。

其中以脊髓內腫瘤發生率最低,治療也最困難,無論是外科手術或放射治療,預後多不佳,常見癱瘓後遺症。而影響到脊椎骨的腫瘤大多是轉移性腫瘤,像乳癌、肺癌、腎癌、前列腺癌等,都會常造成脊椎骨的轉移,造成脊椎病理性骨折壓迫神經,腫瘤甚至直接入侵硬膜外空間包圍脊髓造成壞死。

脊椎內腫瘤的症狀

脊椎內腫瘤會造成的症狀大致可以分為脊髓病變、神經根病變、及脊椎損傷。 影響到脊椎骨的腫瘤大多是轉移性腫瘤繼發性癌症 (metastasis),如果破壞脊椎這條大樑的構造,身體將如危樓,軀幹不但再也沒有辦法承受體重及運動,脊椎內的脊髓也可能引發病變而導致手腳的癱瘓以及劇烈的神經痛。手術重建這條大樑是當務之急。

脊椎骨的骨髓組織被腫瘤組織掏空之後,脊椎骨將無法承受體重而造成壓迫性骨折。胸椎脊椎骨腫瘤的病人會突然感到背痛加劇、肢體無力、大小便困難,感覺麻木、無法行走而需要坐輪椅。如果是高位頸椎脊椎骨的轉移,甚至會造成四肢癱瘓呼吸衰竭而死亡。

脊椎管腔內良性腫瘤不會轉移到其他部位,也不會有立即性生命危害,但因生長在脊椎管腔內,體積大時會壓迫脊髓神經,產生類似坐骨神經痛的症狀,嚴重時會導致下半身癱瘓。故如遇無法改善的坐骨神經痛便應及早尋求腦神經外科專科診治。

不論是原發性或是轉移性腫瘤,如果不妥善處理,最終會損害脊髓及脊椎神經而導致疼痛、癱瘓、甚至危及生命。

脊椎腫瘤的治療

在短短十年前,醫學界總有一種觀念,認為開刀切除脊髓內腫瘤是極端危險以及切不乾淨的,治療多半以手術切片及放射治療為主。隨著醫療科技的進步與突破,近年已陸續的有醫學文獻指出,脊髓內部的腫瘤,尤其是室管膜瘤,是可以經由精細的手術,將脊髓縱向剖開,在利用顯微手術的技巧,將腫瘤徹底的切除而永絕後患,這是十年來神經外科觀念及技術的大突破。

原發性脊椎內腫瘤多數都可以用精湛的顯微手術徹底切除,以絕後患。硬膜內脊髓外腫瘤多為良性瘤,手術治療有非常好的成效,脊髓內的腫瘤以室管膜瘤最為常見,一般認為摘除非常困難危險性很大,事實不然。在精細的顯微手術下配合手術中誘發電位的監測,這類腫瘤多半可以完全切除,永絕後患。

影響到脊椎的轉移性腫瘤,常侵蝕脊椎骨造成病理性骨折或者是壓迫性脊髓病變而造成癱瘓等不良後遺症。但若經過仔細評估,及早治療,一般都可以治癒的。精細的手術雖可將神經損傷的可能性降至最低,但是不太可能將已喪失的神經功能恢復回來。手術剛結束的兩三個月,病人仍需要接受積極的復健,才可將神經功能漸漸地恢復到術前的水準。

影響到手術癒後的因素如下列幾項:

  1. 腫瘤的大小
  2. 術前神經缺損的嚴重程度
  3. 腫瘤所生長的位置。

腫瘤長得愈大,症狀拖延的時間愈久或者是症狀愈嚴重,病人術後想恢復術前的神經功能,相對的也比較困難。相對的,生長在胸椎部分的脊髓內腫瘤,術後的恢復也比較困難。由此可見,及早診斷及治療的重要性。

雖然脊髓內腫瘤手術不太容易,但目前結合影像醫學、顯微手術,成功案例辺不少,有些病人術後一週就能行動自如,而且能夠恢復大部分神經功能。所以,患者不必諱疾忌醫,家族中若有脊髓腫瘤病史,或常感覺手臂、胸頸、腰背疼痛、手腳麻木、走路不穩、身體僵硬等症狀,建議及早接受腦神經外科醫生的檢查,以免延誤治療。