摘要
目的探讨脊髓栓系综合征合并末端脊髓空洞症的发病机制。方法选取我院2008年9月至2014年9月收治的38例脊髓栓系综合征合并末端脊髓空洞症患儿为试验组,同期收治的18例单纯脊髓栓系综合征患儿为对照组。试验组根据末端脊髓空洞大小分别采取不同的手术方式,对照组仅行脊髓栓系松解术,2组患儿术前及术后均应用磁共振成像(MRI)相位对比电影法测定椎管内脑脊液流速,观察脑脊液动力学改变,并随访临床症状的改善程度。结果试验组患儿术前MRI相位对比电影法显示空洞部位蛛网膜下腔脑脊液循环梗阻,脑脊液流速较慢,术中均发现空洞部位蛛网膜增厚,蛛网膜下腔粘连,术后空洞大部分明显缩小,MRI相位对比电影法显示脑脊液循环通畅,脑脊液流速增快,手术前后流速比较差异有统计学意义(P<0.05);对照组患儿术前、术后MRI相位对比电影法显示脑脊液流速无明显变化(P>0.05),术中未发现蛛网膜增厚、粘连;术前试验组与对照组脑脊液流速比较差异有统计学意义(P<0.05)。2组患儿术后临床症状大部分明显改善。结论脊髓栓系综合征合并末端脊髓空洞症的发病机制与脊髓蛛网膜下腔梗阻导致脑脊液动力学改变密切相关,根据MRI显示空洞/脊髓大小选择不同的手术方式可取得良好的治疗效果。
Objective To investigate the pathogenesis of tethered cord syndrome （TCS） and terminal sy-ringomyelia （TS）. Methods Thirty-eight children with TCS and TS, who were hospitalized in our hospital between September 2008 and September 2014, were included in the experimental group. A contemporary cohort of 18 children with simple TCS was included in the control group. The experimental group underwent different surgeries according to the TS size, whereas the control group underwent release of tethered cord alone. The flow rate of intraspinal cere-brospinal fluid （CSF） was determined by cine phase-contrast MRI （PC-MRI）, and the dynamic change of （CSF） was de-termined in the two groups before and after the operation. The improvement of the clinical symptoms was followed up. Results The children in the experimental group showed obstructed CSF circulation and slow flow rate of CSF at the subarachnoid cavity before the operation; thickened arachnoid at the cavity and adhered subarachnoid cavity during the operation; and most significantly reduced cavity, unobstructed CSF circulation, and increased flow rate of CSF af-ter the operation by PC-MRI. There was statistically significant difference in the flow rate of CSF before and after the operation （P〈0.05）. The children in the control group showed no significant change in the flow rate of CSF before and after the operation by PC-MRI （P〉0.05）, and no thickened and adhered arachnoid during the operation. There was sta-tistically significant difference in the flow rate of CSF between the experimental group and the control group before the operation （P〈0.05）. Most of the clinical symptoms were significantly improved in the two groups after the operation. Conclusion The pathogenesis of TCS and TS is closely related to the obstructed subarachnoid cavity induced-dy-namic change. Good effect can be achieved by different operations according to the size of cavity/spinal cord showed by MRI.
出处
《中国药物与临床》
CAS
2016年第6期795-797,共3页
Chinese Remedies & Clinics
基金
山西省自然科学基金(2011011043-3)
关键词
脊髓
脊髓空洞症
发病机制
Spinal cord
Syringomyelia
Pathogenesis
