特发性脊髓疝误诊分析并文献复习

Idiopathic Spinal Cord Herniation: A Report of a Misdiagnosed Case and Literature Review

目的探讨特发性脊髓疝(idiopathic spinal cord herniation,ISCH)的临床特征及诊断要点,以提高诊断水平。方法对我院收治并误诊的1例ISCH的临床资料进行回顾性分析并复习相关文献。结果本例为中年男性,因左下肢乏力2年、加重1年入院,曾在多家医院诊治,诊断不明确且治疗效果差。入我院后查体发现脐平面以下左侧为主不完全性横贯性脊髓损害表现,行脊髓MR检查示胸8椎体水平走行弯曲成角并向左腹侧疝出硬脊膜下腔,背侧蛛网膜下腔继发增大,周围未见肿块影,考虑为脊髓疝。随后转外科手术证实为ISCH,术后第4周双下肢肌力较前明显恢复,双下肢肌张力及腱反射基本正常。结论特发性脊髓疝临床少见,早期表现为Brown-Sequard综合征,易误诊,及时行脊髓MR检查有助于诊断及鉴别诊断。

Objective To explore the clinical characteristics and diagnosis points of idiopathic spinal cord herniation （ISCH）, in order to improve the diagnosis. Methods A retrospective analysis was performed on clinical data of one misdiag-nosed case of ISCH. And the relevant literatures were reviewed. Results The middle-aged male patient was admitted to our hospital due to weakness in left lower limb for 2 years and aggregation for 1 year. He had been diagnosed and treated in many other hospitals but no clear diagnosis had been made and no effective treatment had been given. During the physical examina-tion in our hospital, incomplete transverse injury of spinal cord was found under umbilical plane given priority to the left side. Spinal MR imaging showed that T8 was bent and angulated deformed to the left of the ventral side, and the herniation was out of the left subdural mater, dorsal subarachnoid secondary enlargement, and no mass was around, and spinal cord herniation was suspected. Then surgery confirmed the patient as having ISCH. 4 weeks after operation, the muscles of double lower limbs apparently recovered, the muscle tone and the reflex returned to normal. Conclusion ISCH is rare in clinical practice. Brown-Sequard syndrome is common in early manifestation, which may easily be misdiagnosed. Early spinal MR examination contributes to diagnosis and identification of the disease.