摘要
目的探讨脊髓空洞分流术治疗脊髓空洞症的疗效。方法对24例脊髓空洞症患者采用单纯“T”管脊髓空洞腹腔分流(SPshunt,16例)和后颅窝减压(PFD)加脊髓空洞分流(8例)治疗,对疗效进行回顾性分析。在8例行后颅窝减压加分流术中,有4例所行分流术为SPshunt,另4例为空洞蛛网膜下腔分流术(SSshunt)。结果在16例行单纯“T”管脊髓空洞腹腔分流术中,10例脊髓空洞症合并ChiariⅠ畸形伴脊髓损害,其中7例症状明显改善,2例病情稳定无发展,1例1年后症状加重,影像学显示空洞复发;另1例脊髓空洞症并ChiariⅠ畸形伴脊髓受损及枕大孔区综合征,术后脊髓症状明显好转,但枕大孔区综合征无改善;5例外伤性脊髓空洞症患者,术后脊髓受损症状改善。采用PFD加空洞分流治疗的8例合并ChiariⅠ畸型的脊髓空洞症患者既有脊髓损害又有枕大孔区综合征表现,术后枕大孔区综合征均明显改善,而脊髓受损症状明显改善仅6例(4例PFD+SPshunt,2例PFD+SSshunt),1例病情稳定,1例病情加重。结论脊髓空洞症合并ChiariⅠ畸形伴单纯脊髓损害以及外伤性脊髓空洞症患者可采用单纯“T”管SPshunt治疗,效果满意。对于合并ChiariⅠ畸形脊髓空洞症伴脊髓损害及枕大孔区综合征的患者,后颅窝减压术加SPshunt可取得好的疗效。
Objective To evaluate the therapeutic effectiveness of the syrinx cavity shunt for syringomyelia (SM).Methods Twenty-four cases of SM treated with single “T” tube syrinx-peritoneal shunt (S-P shunt, group A, 16 cases) or with posterior fossa depression (PED) in combined with syrinx cavity shunt (group B, 8 cases). Among 8 cases in group B, 4 cases were subjected to PFD+S-P shunt, and the remaining 4 cases to PFD+syrinx-subarachnoid shunt (S-S shunt).Results In 16 cases of group A, of the 10 SM cases associated with Chiari Ⅰ malformation only having clinical presentations of spinal cord impairment, 7 cases achieved postoperative improvement, 2 cases were stable and one case was aggravated one year after operation, showing recurrent syringomyelia in MRI. In one SM case with syringomyelia-chiari Ⅰ malformation having both neurological deficits of spinal cord impairment and clinical manifestations of foramen magnum syndrome, the symptoms of spinal cord impairment were improved after operation, but the presentations of foramen magnum syndrome were not improved. In 5 cases of traumatic syringomyelia, the symptoms of spinal cord impairment were significantly improved. In 8 cases subject to PFD combined with syrinx cavity shunt, the symptoms of foramen magnum syndrome in all patients were improved postoperation, while the neurological deficits of the spinal cord impairment were improved in only 6 cases (4 cases: PFD+S-P shunt; 2 cases: PFD+S-S shunt), the disease condition was stable in one case and aggravated in 1 case respectively.Conclusion Syringomyelia complicated with Chiari Ⅰ malformation only present with spinal cord impairment and traumatic syringomyelia can be effectively treated with S-P shunt. PFD in combination with S-P shunt can be used to effectively treat syringomyelia complicated with Chiari Ⅰ malformation having both spinal cord impairment and formen magnum syndrome.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2005年第3期339-341,共3页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
