摘要
目的观察合并脊髓纵裂（split cord malformation，SCM）的先天性脊柱畸形（congenital spinal deformity，CSD）的影像学特征及伴发椎管内其他畸形的情况，并探讨其与神经损害的相关性。方法回顾性分析自2007年1月至2014年10月105例合并SCM的CSD患者的病历资料及影像学资料，根据Pang分型Ⅰ型与Ⅱ型分组，采用单因素的Х^2检验及多因素Logistic回归分析影像学特征（纵裂类型、纵裂位置、纵裂与顶椎位置关系、分隔的脊髓对称性）及椎管内其他畸形与神经损害的关系。结果105例患者中先天性脊柱畸形类型为形成障碍28例（26．7％，28／105），分节不良33例（31．4％，33／105），混合型44例（41．9％，44／105）；有神经损害表现41例，无神经损害表现64例，Ⅰ型SCM位于胸段11例，胸腰段18例，腰段20例，Ⅱ型SCM位于胸段31例，胸腰段20例，腰段5例，Ⅰ型与Ⅱ型SCM位于脊柱各节段构成比的Х^2检验差异有统计学意义；SCM位于顶椎上29例，顶椎处或跨越顶椎25例，顶椎下51例；SCM分隔脊髓造成78例不对称，27例对称；66例SCM合并椎管内其他畸形，脊髓低位42例，脊髓空洞症38例，脊膜膨出10例，骶管囊肿5例；Ⅰ型、Ⅱ型SCM伴发各种椎管内畸形的比例相似，SCM伴发椎管内其他畸形时神经损害发生率增加（伴发椎管内其他畸形时48．5％，不伴时23．1％）。行单因素的r检验及多因素Logistic回归分析发现腰段SCM、脊髓不对称及脊髓低位易出现神经损害。结论合并SCM的CSD患者，Ⅰ型SCM多见于混合型脊柱侧凸，Ⅱ型多见于分节不全型；Ⅰ型好发于胸腰段以下，Ⅱ型好发于胸腰段以上；SCM伴发椎管内其他畸形时，神经损害发生率增加；腰段SCM、脊髓对称性和脊髓低位与神经损害的发生有显著相关性。
Objective To analyze the imaging features of congenital spinal deformity （CSD） associated with split cord malformation （SCM） and other intraspinal abnormalities, and to investigate the relationship to neurological symptoms. Methods 105 cases CSD with SCM were retrospectively studied. Analysis the imaging features of SCM （including type of SCM, location of SCM, location and apical vertebrae, symmetry of divided cord） and other intraspinal abnormalities. To investigate the relationship of the factors and neurological symptoms using Chi-square test of one factor and multiple factors logistic regression analysis. Results 28 cases （26.7%） were formation failure, 33 cases （31.4%） were segmentation failure, and 44 cases （41.9%） were combination of 2 disorders. 41 cases had neurological symptoms, 64 cases were asymptomatic. The distribution of SCM combined with spinal deformities： thoracic （11 cases）, thoracolumbar （18 cases） and lumbar （20 cases） in type Ⅰ SCM, thoracic （31 cases）, thoracolumbar （20 cases） and lumbar （5 cases） in type Ⅱ, none was in cervical. The location of SCM upper than apical vertebrae 29 cases, on apical vertebrae 25 cases, lower than apical vertebrae 51 cases. Spinal cord was splitted symmetric 27 cases and asymmetric 78 cases. 66 cases combined with other intraspinal abnormalities, lower conus 42 cases, syringomyelia 38 cases, meningocele 10 cases and sakrale zyste 5 cases. Associated with intraspinal abnormalities, the rate of neural symptoms was different. According to Chisquare test of one factor and multiple factors logistic regression analysis, lumbar SCM, spinal cord asymmetric and lower conus were related with neurological symptoms. Conclusion The predilection spinal deformity of type Ⅰ is combination, type Ⅱ SCM is segmentation failure. When SCM patients associated with other iutraspinal abnormalities, the incidence of neurologic symptoms is increased. The lumbar SCM, hemicords asymmetry and lower lying conus have significant relationship with neurologic symptoms.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第2期81-87,共7页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81070698）
关键词
脊柱侧凸
神经管缺损
脊髓空洞症
脊髓疾病
Scoliosis
Neural tube defects
Syringomyelia
Spinal cord diseases
