【精品】脊髓纵裂手术治疗的疗效

【精品】脊髓纵裂手术治疗的疗效 脊髓纵裂手术治疗的疗效 作者:彭军，兰宾尚，樊李瀛，江振华 【摘要】 ,目的,探讨脊髓纵裂手术治疗 效果。,方法,对1978年5月,2006年1月收治的有完整资料的121例单管型及 双管型脊髓纵裂手术及非手术治疗的病例进行回顾性分析，并通过临床神经功能评 分及胫后神经皮层体感诱发电位(PTNCSEP)P40波峰监测，评价其手术治疗的疗 效。,结果,双管型脊髓纵裂通过手术后观察和6个月,15年(平均2年6个月)的 随访发现, 临床神经功能评分及 PTNCSEP术后有明显改变, 尤其是疼痛为主诉的患 者恢复最为明显，手术的总有效率可达86%;单管型脊髓纵裂手术前后无明显变 化。,结论,双管型脊髓纵裂脊髓损害重，且呈进行性加重，精细的手术治疗可以 使大多数患者症状缓解，终止神经进行性损伤，确诊后应尽早手术;单管型脊髓纵 裂脊髓损害轻，不需手术探查。 【关键词】 脊髓纵裂; 手术; 疗效 Abstract: ,Objective,To evaluate the clinical treatment results for diastematomyelia treated by operation. ,Method,Data from patients with diastematomyelia admitted to our hospital from May 1978 to January 2006 were reviewed. According to the classification, there were single-tube in 25 and double-tube in 96 patients. One hundred and two patients with diastematomyelia were treated by operation and ninteen by conservative treatment. The clinical results were retrospectively analyzed according to scoring neural function and monitoring the peak P40 of posterior trivial nerve cortical somatosensory evoked potential (PTNCSEP) before and after treatment.,Result,The total operative effective rate of double-tube diastematomyelia amounted to 86% during a follow-up period of 6 months to 15 years,more significant in patients with pain.The scores of neural function and PTNCSEP were significantly improved. But patients with single-tube diastematomyelia had no obvious change after operation.,Conclusion,The spinal cord is damaged severely in double-tube diastematomyelia and gradually aggravated.Operation can get symptomatic relief in many patients and terminate spinal cord lesion. So operation should be performed as soon as the diagnosis is made. The spinal cord is damaged slightly in single-tube diastematomyelia and surgery is not indicated. Key words:diastematomyelia; classification; treatment outcome 脊髓纵裂是 一种少见的脊髓发育畸形，是由于脊髓被骨性、纤维性或软骨性间隔所固定而产生 一系列脊髓受损的临床现。根据兰宾尚提出的分型方法,1,脊髓纵裂按硬膜管 形态与脊髓的关系分为两型，即双管型和单管型。双管型特征:病变区硬膜管是两 个独立的次管，其内有各自分裂的半脊髓。单管型特征:病变区硬脊膜呈扩大的单 管状，其内包容两个“镜影状”分裂脊髓。文献报道较少，作者从1978年5月至 2006年1月收治135例脊髓纵裂患者，121例有完整资料，其中双管型96例，单 管型25例，行手术治疗102例，取得了良好的疗效。现报道如下。 1 临床资料 1.1 一般资料 本组121例，男43例，女78例;年龄3个月,58岁，平均15.2岁。患 者出现症状年龄3个月,32岁，平均10岁;双管型平均就诊年龄为3岁，单管型 平均就诊年龄为8岁。主要表现为:?畸形，先天性脊柱侧弯，马蹄内翻足;?疼 痛;?运动障碍，单侧或双侧下肢无力，学步晚，行走不稳，摇摆，肌张力高;? 排尿障碍，排尿费力，尿失禁，遗尿;?皮肤特征性改变，血管痣，毛发，皮窦， 色素斑;?发病部位:颈段2例，胸段12例，胸腰段46例，腰段61例。详见表 1。 表1 121例脊髓纵裂临床表现临床表现单管型