椎管病变致急性/亚急性非创伤性脊髓损伤的诊治策略

Investigate the strategy for diagnosis and surgical treatment of acute and subacute nontraumatic spinal cord injury

目的总结椎管内病变致急性及亚急性脊髓损伤的临床特点、诊治和手术治疗策略。方法回顾性分析第三军医大学西南医院神经外科2010年1月至2015年12月住院的46例椎管内病变致急性及亚急性脊髓损伤患者的临床资料,总结其手术治疗效果。结果所有患者均随访3个月以上。其中男27例,女19例,年龄10~70岁,平均40.7岁。入院时ASIA分级:A级9例(19.6%),B级6例(13.0%),C级12例(26.1%),D级19例(41.3%);椎管内病变包括胶质瘤10例,占21.7%;转移瘤5例(10.9%);神经鞘瘤11例(23.9%);脊膜瘤3例(6.5%);肠源性囊肿1例(2.2%);椎间盘髓核4例,占8.7%;血肿5例(10.9%);血管畸形7例(15.2%);46例患者术前均行MRI检查,均行椎管探查、病变切除和(或)椎板减压术。本组8h内手术者,症状和体征明显好转6例(75.0%);8~24h内手术者好转2例(25.0%),超过24h手术者好转25例(83.3%)。结论急性及亚急性脊髓损伤患者应及时行MRI影像检查,明确诊断后急诊行椎管探查、病变切除和(或)椎板减压手术是治疗急性及亚急性脊髓损伤的关键。

Objective To summarize the clinical features,diagnosis and surgical strategies of the acute and subacute nontraumatic spinal cord injury.Methods We analyzed retrospectively 46 cases of patients with acute and subacute nontraumatic spinal cord injury,who were admitted in the southwest hospital between January 2010 and december 2015.We summarized the clinical data and the effects of the surgical treatments.Results Among the 46 patients,There were 27 males and 19 females with mean age of40.7years（10-70）.They were followed up for more than 3months.Neurological function of ASIA at the initial admission included A in 9cases,B in 6,C in 12 and D in 19.There were 5hematoma patients（10.9%）,11 neurilemmoma cases（23.9%）,4cases of acute disc herination（8.7%）,Vascular Malformation 7cases（15.2%）,5meningioma patients（10.9%）,glioma 10cases（21.7%）and enterogenous cyst 1case（2.2%）.46 patients underwent preoperative MRI examination,followed by spinal canal exploration,lesion resection and/or decompression.Operation within 8hours,the signs and symptoms were improved in 6cases.Operation within8-24 hours were improvement in 2cases,Operation after 24 hours improvement in 25 cases.Conclusion Early MR imaging and emergency spinal canal exploration and lesion resection with or without lamina decompression surgery is effective for the treatment of patients with acute and subacute nontraumatic spinal cord injury.