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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 explore the pathogenesis of tethered cord syringomyelia syndromes. Methods Thirty-eight children with tethered syringomyelia syndrome who were treated in our hospital from September 2008 to September 2014 were selected as the experimental group and 18 children with simple tethered cord syndrome as the control group. The experimental group according to the size of the terminal syringomyelia were taken by different surgical methods, the control group was only tethered cord thrombolysis, two groups of children preoperative and postoperative application of magnetic resonance imaging (MRI phase contrast film method for the determination of intraspinal Cerebrospinal fluid flow rate, observed changes in cerebrospinal fluid dynamics, and follow-up clinical symptoms improved. Results Compared with the preoperative MRI phase contrast film method in the experimental group showed that the empty part of the subarachnoid cerebrospinal fluid circulation obstruction, slow cerebrospinal fluid flow velocity, intraoperative and intracranial arachnoid thickening were found, subarachnoid adhesions, most of postoperative cavities (P <0.05). The control group showed significant difference in the flow rate of cerebrospinal fluid between the preoperative and postoperative MRI phase contrast films No significant changes (P> 0.05). No arachnoid thickening and adhesions were found during operation. There was significant difference in cerebrospinal fluid velocity between preoperative test group and control group (P <0.05). Most of the clinical symptoms of the two groups were significantly improved after operation. Conclusions The pathogenesis of tethered syringomyelia syndrome is closely related to the changes of cerebrospinal fluid dynamics induced by spinal cord subarachnoid obstruction. According to MRI, it is feasible to choose different operative methods according to the size of the cavity / spinal cord.