青少年特发性脊柱侧凸患者的中枢神经异常

Central nerve abnormalities in patients with adolescent idiopathic scoliosis

目的 :检查青少年特发性脊柱侧凸 (AIS)患者的后脑及脊髓的结构和功能异常 ,探讨两者间的相关性及与Cobb角的关系。方法 :用MRI探查AIS患者的后脑及脊髓的解剖结构 ,用体感诱发电位 (SEP)检查体感传导通路功能 ,并对两者结果作相关性检验。结果 :MRI见小脑扁桃体脱垂或脊髓空洞和SEP显示体感传导通路功能异常病例在Cobb角 >45°患者中依次占 31%和 2 7 6 % ,而 <45°患者中分别只占 3 7%和 11 9% ,结构异常和功能异常有显著相关性。结论 :对严重脊柱侧凸或合并SEP异常患者应常规行全脊髓MRI检查 。

Objective:To detect and correlate the presence of MRI detected structural disorders and SEPs detected functional disorders in the hind brain and spinal cord in patients with adolescent idiopathic scoliosis(AIS).Method:SEPs and whole spine MRI were performed on patients with AIS.The relation between SEP and MRI outcomes was analysed statistically.Result:Either MRI detected tonsillar ectopia or syringomyelia,or SEPs detected functional disturbance in somatosensory pathway were found to be significantly more frequent in the group of patients with severe scoliosis curvature.Incidence of tonsillar ectopia was 333% in patients with abnormal SEPs in contrast to the much lower incidence of 29% in patients with normal SEPs.There is a significant structural and functional link.Conclusion:Total spine MRI should be performed on AIS patients with severe curvature seen at the first presentation as well as in AIS patients with abnormal SEPs.This would help to identify structural pathology in the hind brain and spinal cord,which may both be a treatable cause of the scoliosis deformity and a hazardous factor during the scoliosis corrective surgery. Author′s address\ Department of Orthopaedics & Traumatology,Prince of Wales Hospitl,Shatin,Hong Kong