26例脊髓血管畸形的临床特征分析

Clinical Characteristics of 26 Cases of Spinal Vascular Malformation

目的分析脊髓血管畸形(SVM)的临床及影像学特征,以提高早期诊断率,改善患者预后。方法回顾性分析2012年10月至2019年10月郑州大学第一附属医院收治的26例SVM患者的临床资料,分析其临床和影像学特征。结果26例患者中硬脊膜动静脉瘘(SDAVF)13例(50%),脊髓动静脉畸形(SAVM)9例(34.6%),髓周动静脉瘘(PMAVF)3例(11.5%),海绵状血管瘤(CM)1例(3.8%)。临床症状:肢体无力23例(88.5%),肢体麻木14例(53.8%),疼痛10例(38.5%),感觉减退、消失或异常8例,大小便障碍9例(34.6%),间歇性跛行、恶心呕吐各2例,步态异常1例,头晕1例。SDAVF病变多位于胸腰段以下,而SAVM、PMAVF和CM病变多位于胸腰段以上。21例(80.8%)SVM患者的磁共振成像(MRI)结果显示脊髓水肿、缺血或信号流空影。结论SVM临床表现多样且无特异性,容易误诊和漏诊。对于进行性瘫痪或四肢瘫痪的患者,要考虑患有SVM的可能。

Objective To analyze the clinical and imaging features of patients with spinal vascular malformation(SVM)in order to improve the early diagnosis rate and prognosis.Methods The clinical data of 26 patients with spinal cord vascular malformation admitted to the First Affiliated Hospital of Zhengzhou University from October 2012 to October 2019 were retrospectively analyzed.Results Of the 26 patients,13(50%)had dural arteriovenous fistula(SDAVF),9(34.6%)had spinal arteriovenous malformation(SAVM),3(11.5%)had perimedullary arteriovenous fistula(pmavf)and 1(3.8%)had cavernous hemangioma(CM).Clinical symptoms:limb weakness in 23 cases(88.5%),limb numbness in 14 cases(53.8%),pain in 10 cases(38.5%),hypoesthesia,disappearance or abnormality in 8 cases,dysuria in 9 cases(34.6%),intermittent claudication,nausea and vomiting in 2 cases,abnormal gait in 1 case,dizziness in 1 case.SDAVF lesions were mostly below the thoracolumbar segment,while SAVM,PMAVF and CM lesions were mostly above the thoracolumbar segment.MRI of 21 patients(80.8%)with SVM showed spinal cord edema,ischemia or signal flow void.Conclusion The clinical manifestations of SVM are various and nonspecific,which are easy to be misdiagnosed and missed.For patients with progressive paralysis or quadriplegia,the possibility of spinal vascular malformation should be considered.