特发性脊髓疝手术治疗11例分析

Surgery for idiopathic spinal cord herniation in 11 cases: a retrospective analysis

目的总结特发性脊髓疝的临床表现、诊断要点、手术方式与临床预后。方法与结果回顾分析2015年8月至2019年12月收治的共11例有明确脊髓神经功能损害症状的特发性脊髓疝患者,临床主要表现为痛温觉减退,其中1例腰腿疼痛伴排尿困难;7例肌无力或肌张力下降,4例肌张力增高;1例发生于颈髓,9例发生于胸髓,1例发生于腰髓;日本骨科协会评分(JOA)平均6.91。影像学可见硬脊膜缺损多位于T4~7椎体之间,相应层面脊髓萎缩和长T2信号。均行脊髓疝复位+硬脊膜瘘口修补术,手术成功率为100%。术后临床症状均改善,术后恢复良好,无脑脊液漏、感染等并发症。术后平均JOA评分为11.55,均较术前明显改善,平均改善率为76.44%。术后平均随访32个月,均未见脊髓疝复发。5例临床症状消失,3例明显改善,3例缓解。结论特发性脊髓疝治疗的难点在于术前诊断与手术方式的选择,早期确诊及手术治疗后临床预后良好。

Objective To investigate the clinical presentation,diagnosis,operative strategy and prognosis of idiopathic spinal cord herniation(ISCH).Methods and Results Clinical data of 11 ISCH cases with definite spinal cord dysfunction enrolled in Hainan Hospital and the First Medical Center of PLA General Hospital from August 2015 to December 2019 were retrospectively analyzed.The main clinical manifestations were hypesthesia of pain and temperature,while one case had lumbocrural pain and dysuria.Myasthenia or hypomyotonia was seen in 7 cases and hypermyotonia in 4 cases.One case occurred in the cervical spine,9 cases occurred in the thoracic spine,and one case occurred in the lumbar spine.The mean Japan Orthopedic Association Scores(JOA) was 6.91.MRI demonstrated that the defect was mostly situated in the level of T4-7 vertebral bodies.Amyelotrophy and T2 hyperintense signal at the corresponding level could be detected.All patients were treated with correction of herniated spinal cord and dural defect repair,and the success rate of surgery was 100%.The postoperative clinical symptoms were improved and the postoperative recovery was well.There were no cerebrospinal fluid leakage and intracranial infection.The mean postoperative JO A score was 11.55,which was significantly improved,and the average rate of improvement was 76.44%.The average follow-up period for 11 patients without recurrence was 32 months.The preoperative clinical symptoms disappeared in 5 cases,improved significantly in 3 cases,and alleviate in 3 cases.Conclusions The difficulties of the treatment of ISCH are the preoperative diagnosis and the choice of the best surgical procedure.Early definite diagnosis and surgical treatment are helpful for clinical prognosis of patients.