脊髓血管畸形的临床特征与影像学分类的相关性研究

Spinal Vascular Malformations: The Correlation between Clinical Characteristics and Imaging Classification

目的：分析研究脊髓血管畸形的临床特征与影像学分类的相关关系。材料和方法：收集了６２例经Ｍ ＲＩ、ＤＳＡ和（或）手术病理证实的髓血管畸形患者，其中髓内隐匿型动静脉畸形（ＡＶＭＳ） １３例、球形ＡＶＭｓ ５例、幼稚型ＡＶＭＳ １２例：髓周膜内动静脉瘘（ＡＶＦ） Ｉ型 Ⅱ例、血型 １２例、 Ⅲ型 ７例；硬膜型 ＡＶＦ８例。结果：脊髓 ＡＶＭｓ中，隐匿型ＡＶＭｓ无明显的性别差异，余各类型男性均多于女性；髓内ＡＶＭＳ、髓周ＡＶＦ以青少年多见，硬膜型ＡＶＦ发生于中老年；髓内ＡＶＭｓ多见于颈髓及胸腰段脊髓，髓周ＡＶＦ及硬膜型ＡＶＦ多见于胸腰段；髓内ＡＶＭｓ以急性起病多见，髓周ＡＶＦ表现为进行性加重，少数可急性发作，硬膜型ＡＶＦ以慢性起病多见；髓内出血者预后较无出血者差。结论：根据临床症状、起病特征可初步判断病变类型，争取早期正确诊断、早期治疗，为减轻临床症状提供条件。

Purpose: To study the correlation between clinical features and imaging classification of spinal vascular malformations(VMs). Materials and Methods: Of 62 patients with spinal AVMs which confirmed by MRI, DSA and/ or pathology, 30cases had intramedullary AVMs(13 occult AVMs, 5 glopular AVMs, and 12 juvenile AVMs) , 24 cases had perimedullary AVF (5 type I ) 12 type Ⅱ ) and 7 typsⅢ ) , and 8 cases had dural AVF. Results: The male patients appeared more than females in spinal cord AVMs, but the occult intramedullary AVMs had the same morbidity The patients with intramedullary AVMs and perimdeullary AVF were younger, in contrast, patients with dural AVF were usually older than 40 years of age. The intra - medullary AVMs were most common located in the cervical and thracic - lumbar spinal cord, the perimedullary AVF and dural AVF were most seen in the low thracic of lumbar region. The most common initial symptom associated with intramedullary lesions was accute onset where as the pro- gressive aggravation was the most common presenting symptom in cases of dural AVF. The prognosis of the patients with intramedullary lesions had hemorrhage was worse than who without hemorrhage. Conclusion: According to typical symptoms and clinical features, early diagnosis of types of spinal cord AVMs should be suggested, suitable examination and therapeutic methods should be taken as early.