脊髓蛛网膜炎合并脊髓空洞的显微手术治疗

Microsurgical management for spinal arachnoiditis accompanied with syringomyelia

目的探讨脊髓蛛网膜炎合并脊髓空洞的显微手术治疗方法。方法回顾性分析经显微外科手术治疗的15例脊髓蛛网膜炎合并脊髓空洞病人的临床资料。根据脊髓蛛网膜炎症黏连的特点分为3型：I型（弥漫黏连型）10例，Ⅱ型（局限黏连型）3例，Ⅲ型（囊肿型）2例。I型行脊髓空洞一胸腔分流术，Ⅱ型行脊髓黏连松解术，Ⅲ型行囊肿探查切除术。结果术后症状明显改善13例，同术前2例。MRJ复查显示：脊髓空洞缩小12例，消失1例，同术前2例。13例术后随访8个月～3年，症状改善9例，同术前3例，加重1例。结论显微手术是治疗脊髓蛛网膜炎合并脊髓空洞的有效方法，根据分型选择合适的显微手术治疗方案，治疗效果较好。

Objective To investigate the microsurgical treatment for spinal arachnoiditis accompanied with syringomyelia. Methods Clinical data of 15 patients undergoing microsurgery for spinal arachnoiditis accompanied with syringomyelia were analyzed retrospectively. The arachnoiditis was divided into three types according to the characters of spinal arachnoiditis： type I with extensive adhesion in 10 patients, type Ⅱ with focal adhesion in 3 and type Ⅲ with arachnoid cyst in 2. Syringopleural shunt was performed in patients with type I arachnoiditis, spinal cord adhesiolysis in patients with type Ⅱ and cyst excision in patients with type Ⅲ. Results The symptoms were obviously improved in 13 patients and remained stable in 2 postoperatively. MRI scan indicated that the syrinx shrank in 12 patients, disappeared in 1 and remained stable in 2. Thirteen patients were followed up for 8 months to 3 years. The symptoms were improved in 9 patients, remained stable in 3 and aggravated in 1. Conclusions Microsurgery is an effective method for treatment of spinal arachnoiditis accompanied with syringomyelia. Selecting suitable microsurgical method according to the type of spinal arachnoiditis could achieve a better treatment effect.