手术治疗脊髓空洞症远期疗效分析.docVIP

手术治疗脊髓空洞症远期疗效分析 发表时间：2008-01-25发表者：郭俭 (访问人次：2386) 手术治疗脊髓空洞症远期疗效分析 摘要 目的 分析手术治疗脊髓空洞症的远期疗效。方法 对我院术后5年以上的脊髓空洞症患者316例进行书面随访及预约复查，分析影响远期疗效的因素。结果 手术后1年内疗效为92.7%；年龄、病程、空洞类型、手术方法是影响近期疗效的主要因素；后颅窝粘连、空洞再扩大、脊髓萎缩可能是影响远期疗效的主要原因。结论 传统手术方法对脊髓空洞症近期疗效较好，远期疗效则无法保障。青岛401医院神经外科郭俭关键词??脊髓空洞症；外科治疗；远期疗效中国图书资料分类号??R744.7?????文献标示码??A Analysis of Long-term??curative effect for surgical treatment of syringomyeliaGUO Jian ,GAO Shuli ,WANG Kai,Tang Shen,ZHU Hongchun,SHEN Chunying.Department of Neurosurgery,401th Hospital of PLA,QingDao 266071,ChinaAbstract Objective??To analyze the long-term curative effect for traditional surgical operation of syringomyelia. Methods??316 cases were visited in writing and made an appointment??to check. the factors of influence the long-term curative effect were analyzed. Results??After operation a year, curative effect is 92.7%.The age, disease distance, empty type, surgical operation is the main factor of the near period in influence curative effect. The adhesion of posterior fossa, syrinx extend again and the spinal cord atrophy??may be main factors to affect the long-term curative effect. Conclusion??The traditional surgical operation is??better to near period curative effect of syringomyelia. the long-term curative effect then cant guarantee.Keywords??Syringomyelia;??Surgical treatment; Long-term curative effect 脊髓空洞症是一种脊髓内慢性进行性疾病，主要表现为脊髓内管状囊腔形成，囊壁为胶质增生，颈髓及上胸髓易受累。按病因可分为先天性及后天性两种。先天性脊髓空洞多伴有小脑扁桃体及延髓联合畸形；后天者可能与蛛网膜炎、外伤、肿瘤、血管病、变性病等有关[1~2]。目前主要以手术治疗为主。我院自1984.2至今共收治各类脊髓空洞症患者1 800余例，近期疗效较好。近年来发现，随着时间推移，患者症状再度出现甚至加重。为了解手术远期疗效及其影响因素，作者对术后5年以上的患者316例行书面及MRI随访，并对随访资料进行回顾性分析。对象与方法一、临床资料1.一般资料:随访 316例。其中男151例，女165例。男：女为1：1.1。手术时年龄14~62岁，平均30.1岁。病程1个月~40年，平均9.3年。2.首发症状：上肢麻木无力233例，感觉减退、怕冷、肢体痛270例，颈肩不适218例，症状为单侧263例，双侧53例。下肢麻木无力46例，胸腹部束带感62例。3.术前MRI检查：316例均经MRI检查证实，其中小脑扁桃体下疝（Arnoid Chiari maformation ACM）伴脊髓空洞（Syringomyelia SM）162例。单纯空洞154例。合并枕大池囊肿3例，脊髓蛛网膜囊肿2例；椎管肿瘤3例。空洞位于颈段68例，颈胸段204例，胸腰段36例；腰段6例，全脊髓空洞2例。4.术前症状及体征：一侧面部无汗或少汗173例，后组颅神经症状143例，