142例脊髓纵裂合并骨性分隔患者的临床诊疗探讨  

Diagnosis and treatment for 142 patients of split cord malformations with osseous divide

作　　者：王涛[1] 林伟[2] 史铁钧[1] 李科[3] 王伟[4] 白小军[1] 顾建文[1] 崔绍杰[1] 

机构地区：[1]解放军第306医院神经外科,北京100010 [2]第四军医大学西京医院神经外科,陕西西安710032 [3]解放军第306医院影像科,北京100010 [4]南方医科大学第三临床医学院,广东广州510515

出　　处：《中华神经外科疾病研究杂志》2017年第5期397-401,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨脊髓纵裂合并骨性分隔伴发脊柱侧弯的手术治疗要点。方法回顾性分析总结142例脊髓纵裂合并骨性分隔及脊柱侧弯的手术选择及手术方法,并对其手术注意事项及影像学诊断进行探讨。结果 142例患者行骨性分隔切除硬脊膜囊成型手术均取得很好效果,未发生脊髓及神经严重损伤等并发症,部分患者术前的尿便障碍、肌力减退、高弓足、足趾活动障碍得到不同程度的缓解,同时也为下一步脊柱侧弯矫形创造了很好的条件。结论脊髓纵裂合并骨性分隔的诊断主要依靠影像学检查显示,MRI平扫联合CT三维重建,可对脊髓纵裂畸形类型及其间隔性质和脊髓纵裂伴发病变做出全面评价。单纯脊髓纵裂可不予处理,外科手术是治疗脊髓纵裂合并骨性分隔的唯一手段。术中分块切除骨性分隔、仔细游离脊髓并重塑硬脊膜囊,可为解除脊髓栓系、改善神经功能症状及下一步脊柱侧弯矫形手术打下良好基础,对于生长发育期的青少年尤为重要。Objective The surgery, and therapy of diastematomyelia with osseous divide and sco]iosis were discussed.Methods Surgical choice, operative methods, the direction to the surgery and imaging diagnosis of 142 cases of diastematomyelia patients with osseous divide and scoliosis were reviewed. Results All patients achieved a satisfactory result by osseous divide resection and lumbosacral dural sac plasty, which provided a good basis for the further sculiosis instrumentation. Primary nerve damage symptoms were lightened or eliminated in some patients. Conclusion Before surgical iustmmentation, all scoliosis patients should be performed spinal X-ray, CT and MRI examination to detect the diastematomyelia and osseous divide. The combination of CT and MRI imaging can be helpful for determining the types of diastematomelia and associated malformation, and can provide more diagnostic value for operation. Sole diastematomyelia does not need any treatment. Patients with diastematomyelia and osseous divide should accept osseous divide resection and lumbosacral dural sac plasty before spinal instrumentation operation, which is very important for young patients in period of growth.

关 键 词：脊髓纵裂 脊柱侧弯 诊断 治疗 

分 类 号：R682.3[医药卫生—骨科学]