经脊髓背根入髓区入路空洞-蛛网膜下腔分流术治疗偏心型脊髓空洞症的临床疗效  

Clinical therapeutic efficacy of syringomyelia-subarachnoid shunt via the dorsal root entry zone approach for the treatment of eccentric syringomyelia

作　　者：张腾飞 陈荣彬 陈文 戴大伟 Zhang Tengfei;Chen Rongbin;Chen Wen;Dai Dawei(Department of Neurosurgery,the Second Afiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院神经外科,上海200003

出　　处：《中华神经外科杂志》2023年第5期490-494,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82201519);院级课题金字塔(YQ684)。

摘　　要：目的 探讨经脊髓背根入髓区(DREZ)入路空洞-蛛网膜下腔分流术治疗偏心型脊髓空洞症的临床疗效.方法 回顾性分析2018年6月至2021年6月海军军医大学第二附属医院神经外科收治的21例特发性或病因治疗无效的继发性偏心型脊髓空洞症患者的临床资料.空洞均位于颈、胸髓.患者均接受DREZ入路直形引流管空洞-蛛网膜下腔分流术.采用改良日本骨科协会(mJOA)腰痛量表评分评估临床症状的改善情况,采用MRI评估脊髓空洞的改善情况(空洞体积缩小≥50%为明显改善).结果 21例患者手术均成功.术后出现暂时性上肢麻木及脑脊液漏各1例,无一例患者出现分流管堵塞、中枢神经系统感染及死亡.术后3、12个月随访,分别有17例(81.0%)、20例(95.2%)患者的临床症状改善;mJOA腰痛量表评分分别为(11.6±1.1)分、(11.3±1.3)分,与术前的(8.1±1.3)分比较均改善,差异有统计学意义(P<0.001).影像学随访显示,术后3个月,19例(90.5%)患者的脊髓空洞明显改善;术后12个月,20例(95.2%)患者的脊髓空洞明显改善.结论 对于特发性或病因治疗无效的继发性偏心型脊髓空洞症患者,采用经DREZ入路空洞-蛛网膜下腔分流术是安全且有效的治疗方法.Objective To investigate the clinical therapeutic efficacy of syringomyelia-subarachnoid shunt via the dorsal root entry zone(DREZ)approach for the treatment of eccentric syringomyelia.Methods A retrospective study was performed on the clinical data of 21 patients with idiopathic or secondary eccentric syringomyelia(with failure in etiological treatment)and admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Naval Medical University from June 2018 to June 2021.Cavities were located in the neck and thoracic spinal cord.All patients underwent syringomyelia-subarachnoid shunt via DREZ approach.The modified Japanese Orthopedic Association(mJOA)low back pain scale was used to evaluate the improvement of clinical symptoms,and MRI was used to evaluate the improvement of the syringomyelia(reduction of the cavity volume by≥50% was considered significant improvement).Results All 21 patients underwent successful operations.Temporary upper extremity numbness and cerebrospinal fluid leakage occurred in 1 case after operation,and no case of shunt blockage,central nervous system infection or death occurred in any patient.After 3 and 12 months of follow-up,17(81.0%)and 20(95.2%)patients had improved clinical symptoms;the mJ0A low back pain scale scores were 11.6±1.1 points,11.3±1.3 points respectively,and both showed improvement compared with preoperative conditions(8.1±1.3 points)(P<0.001).Imaging follow-up showed that the syringomyelia of 19 patients(90.5%)was significantly improved at 3 months after operation,and the syringomyelia of 20 patients(95.2%)was significantly improved at 12 months after operation.ConclusionFor patients with idiopathic or secondary eccentric syringomyelia with failed etiological treatment,syringomyelia-subarachnoid shunt via DREZ approach is a safe and effective treatment.

关 键 词：脊髓空洞症 偏心型空洞 脊髓背根入髓区 空洞-蛛网膜下腔分流术 治疗结果 

分 类 号：R651.2[医药卫生—外科学]