硬脊膜动静脉瘘28例误诊及预后分析

Misdiagnosis and prognosis of spinal dural arteriovenous fistula in 28 patients

目的总结硬脊膜动静脉瘘的误诊原因及对预后的影响,提高其早期诊断和治疗比例,提高治疗效果。方法搜集并回顾性分析本单位近6年收治的硬脊膜动静脉瘘患者52例,并予以随访,将28例误诊患者和另外24例比较,分析患者的误诊和延误治疗原因、诊治方法和术后随访结果。结果 52例患者中有15例(28.85%)曾被诊断为"脊髓炎、脊髓空洞症、蛛网膜炎或脱髓鞘疾病等",13(25%)例曾被诊断为"椎间盘突出或椎管狭窄",其中8例接受了颈椎或腰椎手术治疗,3例(5.77%)曾被诊断为"前列腺增生症,前列腺炎"。52例均经手术和栓塞治疗治愈;随访患者术后症状多得到不同程度的改善,但早期得到确诊和治疗的患者预后较误诊的患者改善更显著。结论硬脊膜动静脉瘘临床症状不典型,易于和椎间盘突出、脊髓病混淆,容易误诊误治,早期诊断和及时治疗可以更好地改善预后。

Objective The causes for misdiagnosis of spinal dural arteriovenous fistulas are summarized and its effect on prognosis are investigated in order to improve the ability of early diagnosis and the outcome of patients with SDAVFs. Methods Clinical data of 52 patients with SDAVFs admitted to our hospital in recent 6 years were analyzed retrospectively. The causes of misdiagnosis and delays in treatments of 28 patients were comp with the other 24 patients. The treatment and the follow-up results were discussed. Results In 52 patients, 15 （28.85%） were diagnosed as myelopathy, syringomyelia, spinal arachnoiditis, or demyelinating diseases. Thirteen （25%） were diagnosed as disc herniation or spinal stenosis, which received the cervical or lumbar spine surgery, in which 8 cases were performed the surgery and 3 （5.77%） were diagnosed as benign prostatic hyperplasia or prostatitis. All patients were performed the surgical treatment or endovascular embolization. Prognosis of patients with early diagnosis and treatment was improved significantly. Conclusion SDAVFs is non-typical in clinical symptoms, so it is hard to differentiate from disc herniation and spinal cord diseases. Early diagnosis and treatment could improve the prognosis of SDAVFs.