脊髓后正中沟造口内引流术治疗脊髓空洞症的效果观察

The effect of internal drainage in posterior median sulcus of spinal cord for syringomyelia

目的:探讨脊髓后正中沟造口内引流术治疗脊髓空洞症的临床疗效。方法:2004年～2006年对12例脊髓空洞症患者行脊髓后正中沟造口内引流术治疗,男9例,女3例;年龄19～57岁,平均26.8岁。术前均行MRI检查,空洞部位:颈段7例(C2～C61例,C2～C72例,C3～C73例,C4～C71例),颈胸段4例(C4～T82例,C4～T101例,C5～T91例),颈胸腰段(C5～L2)1例。其中伴Chiari-Ⅰ畸形6例,合并髓内肿瘤1例,合并脊髓蛛网膜炎2例,余无脊柱脊髓畸形。按Tator标准判定手术效果。结果:术中无严重头痛及死亡等并发症,术后发热2例,3d后体温正常;术后头痛2例,术后7d缓解。随访6～25个月,平均10个月,手术效果优9例,良2例,差1例。1例患者术后15个月时因髓内室管膜瘤复发压迫致临床症状加重。末次随访时复查MRI示空洞消失1例、明显缩小或呈裂隙状8例,无变化2例,扩大1例。结论:应用脊髓后正中沟造口内引流术治疗脊髓空洞症近期效果好,是合理且有效的手术方法。

Objective：To investigate the practical effects of surgery treatment by the application of internal drainage in the posterior median sulcus for syringomyelia （SM）.Method：12 patients with SM who underwent surgical treatment from 2004 to 2006 were analyzed retrospectively.There were 9 males and 3 females with age ranged from 19 to 57 years （mean 26.8 years）.MRI were obtained preoperatively in all the patients.The position of syrinx-cavities were 7 cases in cervical cord,4 cases in cervical-thoracic cord and 1 case in cervical-lumbar cord.There were 6 cases with Chiari-Ⅰ malformation, 1 case with intermedullary tumor,2 cases with adhesive spinal arachnoiditis and the others without abnormal findings.Tator＇s grade was used to evaluate the clinical effect.Result：The follow-up ranging from 6 months to 25 months（10 months on average） showed that all of the patients had no complications in the operation.Fever in 3 days and headache in about 7 clays were main,earlier postoperative complications.But 1 case was aggravated by recurred ependymocytoma. The syrinx-cavities in 9 cases were obviously shrinked,2 cases were no change and 1 case was expanded. Improvement of clinical symptoms was obtained in 9 cases and symptoms were stabilized in 2 cases postoperatively.Only 1 case got worse after operation.Conclusion：The internal drainage is a reasonable and reliable method to treat SM and provides good result in the near future.