外伤后颈髓空洞症九例临床分析

The clinical analysis of 9 cases with posttraumatic cervical syringomyelia

目的回顾分析外伤后颈髓空洞症的症状、体征及影像学改变,探讨显微外科手术对颈髓空洞症的治疗效果。方法9例患者于颈椎损伤后7个月至6年经CT和MRI检查确诊为颈髓空洞;采取显微外科手术治疗;8例患者进行8个月至5年的随访以评判治疗效果。结果外伤后颈髓空洞症最常见症状包括疼痛,感觉缺失和肌力减退等。术后7例症状不同程度改善,2例无明显变化。MRI示1例空洞无明显变化,8例空洞不同程度缩小及消失。结论外伤后颈髓空洞可加重原有的神经损害,MRI是诊断脊髓空洞的金标准。神经功能障碍逐渐加重的脊髓空洞症患者宜接受显微外科手术治疗,可根据病变特点选择椎板切除减压术、空洞切开分流术治疗等外科术式,手术效果较好。

Objective To analyze retrospectively the clinical manifestations, signs and radiological features of posttraumatic cervical syringomyelia and investigated results of treatment using microsurgical technique. Methods Data from 9 patients with posttraumatic syringomyelia admitted to our hospital from year 1998 to 2004 were analyzed retrospectively. The latent periods ranged from 7 months to 6 years. The diagnosis was confirmed by CT and MRI. The patients underwent decompression or syringo-subarachnoid shunting with microsurgery. 8 cases were followed-up from 8 months to 5 years and the treatment results were evaluated. Results The most commonly presenting symptoms are radicular pain, weakness and sensory loss. During the early postoperative period, 7 of 9 cases showed an improvement of their symptoms complained preoperatively whereas 2 remained stable, without major complication and death. MRI scan indicated that the decreased size or collapse of the syrinx was achieved in 8 patients. Conclusions Posttraumatic syringomyelia is an uncommon but disabling sequel to spinal cord damage, developing months to years after injury. MRI scans is the standard technique for syringomyelia. The patients of syringomyelia with progressive neurological deterioration should be microsurgically treated. To some patients with kyphosis or cord compression, surgical decompression may be an alternative method of surgical treatment for syringomyelia.