无神经症状的脊柱侧凸伴脊髓空洞症患者应否外科处理脊髓空洞的临床研究  

Should syrinx be treated in patients with scoliosis complicated by syringomyelia without neurologic symptom

作　　者：张宏其[1] 陈凌强[1] 郭超峰[1] 刘少华[1] 陈静[1] 罗继[1] 向伟能[1] 鲁世金[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙410008

出　　处：《中国矫形外科杂志》2008年第13期961-965,共5页Orthopedic Journal of China

基　　金：湖南省科技厅科技计划一般项目(06SK3015;2007SK3036);湖南省卫生厅科研课题一般项目(B2006-040)

摘　　要：[目的]探讨伴脊髓空洞症的脊柱侧凸患者在无神经症状且达到矫形指征时应否于矫形之前对脊髓空洞进行外科处理。[方法]实验组（A组）：回顾总结2001年6月～2006年6月本科采用单纯矫形手术而不外科干预脊髓空洞的方法治疗的15例无神经症状的脊柱侧凸并脊髓空洞症患者，测量术前、术后、随访时的冠状面Cobb＇s角以及脊髓空洞的长度、位置，空洞最大直径及S／C比值；对照组（B组）：随机抽取同一时段同一手术组医生采用相同方法治疗的20例AIS患者，测量术前、术后、随访时的冠状面Cobb＇s角。比较A、B两组病例的冠状面矫形率和丢失率；比较A组术前和随访时脊髓空洞的长度、最大直径、S／C比值。[结果]A、B两组矫形率和丢失率无明显差异（P〉0．05），A组脊髓空洞情况术前与随访时进行比较，空洞直径、S／C比值及脊髓空洞长度较随访时明显变小（P〈0．05）。[结论]（1）无神经症状的脊柱侧凸并脊髓空洞患者，脊髓空洞可自发性的减小、吸收，使侧凸停止或减慢进展，进而使该类病人于矫形术后不会产生过多的矫形丢失。（2）对于无神经症状的脊柱侧凸并脊髓空洞患者，脊髓空洞的存在会让术者在矫形时有所顾忌，但只要方法得当，尽量避免牵拉脊髓，在准备充分的情况下仅行矫形手术而不对脊髓空洞做外科处理，并不会影响矫形的效果。[ Objective] To investigate whether syrinx should by treated before eorreetion in patients with seoliosis eomplieated by syringomyelia without neurologie impairment. [ Method ] Thirty -five eases were divided into experimental group （group A, without preoperative surgieal intervention to syrinx, 15 eases） and eontrol group （group B, with preoperative surgieal intervention, 20 eases） randomly. The coronal plane Cobb＇s angle, the length of syrinx, the position of syrinx, the biggest diameter of syrinx and S/C ratio were measured and eompared between 2 groups. [ Result ] There was no signifieant differenee in the correction rate and loss rate between two groups. The postoperative syrinx index （biggest diameter of syrinx, syrinx length and S/C ratio） was significantly smaller than that of preoperation （ P 〈 0.05 ） . [ Conclusion ] （ 1 ） The syrinx could be absorbed and diminished automatically after eorreetion. （2） The syrinx wouldnt affeet the eorreetion rate and has no need to be eorrected before operation.

关 键 词：脊柱侧凸 脊髓空洞 矫形 Cobb's角 

分 类 号：R682[医药卫生—骨科学] R744.4[医药卫生—外科学] R687.3[医药卫生—临床医学]