脊髓背侧蛛网膜网带一例并文献复习  

Spinal Cord Dorsal Arachnoid Web:a Case Report and Literature Review

作　　者：闫维罡 李志伟 李家怡 李登宇 王坤 李文庆 张斌青 YAN Wei-gang;LI Zhi-wei;LI Jia-yi;LI Deng-yu;WANG Kun;LI Wen-qing;ZHANG Bin-qing(Department of Spine Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang 471002,Henan Province,China;Medical Imaging Center,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang 471002,Henan Province,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)脊柱外科,河南洛阳471002 [2]河南省洛阳正骨医院(河南省骨科医院)影像中心,河南洛阳471002

出　　处：《罕少疾病杂志》2024年第12期6-7,共2页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨脊髓背侧蛛网膜网带的临床特征、影像学表现、诊断治疗,旨在提高临床医师对该病的认识。方法对1例曾被误诊为腰腿痛疾病的脊髓背侧蛛网膜网带患者进行临床资料总结并复习国内外文献,对该病相关的特征及诊治进行总结。结果该68岁女性患者以腰痛及双膝关节疼痛双下肢僵硬无力、活动不便为主要表现,来院就诊,经详细查体及系统检查后,腰椎及膝关节退行性改变不能全面解释该临床表现,而胸椎MR显示T6椎体水平脊髓受压变细,背侧局部蛛网膜下腔间隙增宽,呈“手术刀征”改变。结合临床体征,明确诊断并进行手术,术中所见胸髓背侧蛛网膜网带,压迫脊髓,给予切除蛛网膜网带后,脊髓膨隆,术后症状改善,病理学检查与术前诊断相符,随访病人恢复良好。结论脊髓背侧蛛网膜网带是一种罕见的临床病变,影像学可表现出典型的特征,但该病病情发展迟缓,于老年人而言,易与退行性疾病所引起的临床症状相重叠,临床中容易被忽视,通过本例病例的回顾分析和相关文献复习,以加深对该疾病的认识,为临床工作提供参考,降低该病的漏诊、误诊率。Objective To explore the clinical features,imaging manifestations,diagnosis and treatment of the spinal dorsal arachnoid web,with the aim of improving the understanding of this disease among clinical physicians.Methods Clinical data of a patient with thoracic spinal dorsal dorsal arachnoid web who was previously misdiagnosed as low back and leg pain disease were summarized,and domestic and foreign literature was reviewed to summarize the characteristics,diagnosis and treatment of the disease.Results The 68 year old female patient came to the hospital with the main manifestations of low back pain and pain in both knees,stiffness and weakness of both lower limbs,and difficulty in movement.After detailed physical examination and systematic examination,the degenerative changes in the lumbar spine and both knees could not fully explain the clinical manifestations.The thoracic spine MRI showed that the spinal cord at the level of T6 vertebral body was compressed and narrowed,and the local space of the subarachnoid space at the back was widened,presenting the"Scalpel sign"change.Combined with the clinical signs,a clear diagnosis was made and the operation was carried out.The arachnoid web at the back of the thoracic spinal cord seen during the operation compressed the spinal cord.After the arachnoid web was removed,the spinal cord swelled,and the postoperative symptoms improved.The pathological examination was consistent with the preoperative diagnosis.The follow-up patients recovered well.Conclusion The spinal cord dorsal arachnoid web is a rare clinical lesion with typical imaging features.However,the disease develops slowly,and is easy to overlap with the clinical symptoms caused by Degenerative disease in the elderly.It is easy to be ignored in clinical practice.Through the retrospective analysis of this case and the review of relevant literature,we can deepen the understanding of the disease,provide reference for clinical work,and reduce the rate of missed diagnosis and misdiagnosis of the disease.

关 键 词：脊髓背侧蛛网膜网带 手术刀征 脊髓受压 磁共振成像 退行性疾病 漏诊 误诊 

分 类 号：R681.5[医药卫生—骨科学] R651.2[医药卫生—外科学] R445.2[医药卫生—临床医学]