摘要
目的探讨对临床上无明显神经损害的“特发性”胸椎左侧凸患者存在的脊髓病变情况，并分析其临床意义。方法1997年10月至2003年10月共诊治“特发性”胸椎左侧凸59例，其中男性31例，女性28例；年龄7～44岁，平均15岁；Cobb角15°～108°，平均56°。所有病例经临床及影像学检查，排除神经纤维瘤及先天性脊椎发育异常等病因。对临床诊断为“特发性”胸椎左侧凸的患者行全脊髓磁共振成像（MRI）检查，对脊髓病变的发生率进行统计。结果59例“特发性”胸椎左侧凸患者经全脊髓MRI检查后，共有33例发现髓内病变，髓内病变发生率为56％，其中Chiari畸形合并脊髓空洞24例，脊髓空洞5例，Chiari畸形、脊髓空洞、脊髓裂1例，Chiari畸形、脊髓空洞、脊髓栓系1例，脊髓空洞合并栓系1例，Dandy—Walker畸形1例。其余26例未发现脊髓病变。分析伴有脊髓病变的胸椎左侧凸患者中男性比例及平均Cobb角均显著大于无脊髓病变的胸椎左侧凸（P〈0．05）。结论对于胸椎左侧凸，尤其是男性、Cobb角较大的患者需高度怀疑伴有脊髓病变。对于此类患者术前常规全脊髓MRI检查具有重要意义。
Objective To detect the prevalence of spinal cord abnormality in ＂idiopathic＂ left thoracic scoliosis and analyze its clinical significance. Methods From October 1997 to October 2003, 59 ＂idiopathic＂ left thoracic scoliosis were treated, including 31 males and 28 females. The age was from 7 to 44 years with an average of 15 years. The Cobb angle was from 15° to 108° with average 56°. The holocord MRI was made for all patients. Results Thirty-three patients were found cord abnormality, including 24 Chiari malformation with syringomyelia, 5 syringomyelia, 1 Chiari malformation with syringomyelia and diastematomyelia, 1 Chiari malformation with syringomyelia and tethered cord, 1 syringomyelia with tethered cord, and 1 Dandy-Walker malformation. The prevalence of spinal cord abnormality in left thoracic scoliosis was 56%. Compared to the left thoracic scoliosis without cord abnormality, the left thoracic scoliosis with cord abnormality had been found more in males and the patients with bigger Cobb angle （P 〈0. 05 ）. Conclusions For leftthoracic scollosis, especially male patient or patient with bigger Cobb angle, associated cord abnormality should be highly suspected. Preoperative holocord MRI is very meaningful for this kind of patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2006年第24期1657-1659,共3页
Chinese Journal of Surgery
关键词
脊柱侧凸
胸椎
左侧凸
脊髓病变
Scoliosis
Thoracic vertebrae
Left scoliosis
Spinal cord abnormality
