脊柱脊髓血管畸形的新型分类及其临床应用的研究-神经外科专业论文.docx

摘 摘 要 目的：提出脊柱脊髓血管畸形的新型改良分类，探讨其对治疗的 指导意义；评价提高脊髓血管畸形解剖治愈率的治疗措施的安全性和 有效性；对本组治疗的脊柱脊髓动静脉畸形进行全面总结。资料和方 法：自1986年至2003年3月期问，共收治了脊柱脊髓血管畸形549 例。所有病例按照新提出的分类标准进行划分，对于脊柱脊髓m管畸 形的整体和各病种的构成、男女比例、发病年龄、就诊年龄、首发症 状、病程、病情演变类型、脊柱节段分布、治疗方式、治疗次数、治 疗周期、治疗前、后及随访时的脊髓功能评分、功能状况、功能疗效、 病变消失程度的影像结果、综合疗效进行统计分析。2000～2003年3 月在新型分类的指导下，前瞻性地改变了脊髓血管畸形栓塞和手术的 治疗方案，将治疗结果加以总结，与以往进行比较，评价新分类的应 用以及栓塞和手术技术的改进对疗效的影响。结果：新型分类可覆盖 本组所有疾患，并且没有重叠。脊髓血管畸形的总体长期治愈好转率 为82．2％，95％以上的病变消失率为62．6％。在新分类的指导下和改 进治疗技术以后，与以往结果相比，在保持治疗后早期功能没有加重 的前提下，提高了脊髓血管畸形的影像消除率，95％以上病变消失率 达87．2％，并且-显著缩短了治疗周期。结论：脊柱脊髓血管畸形的新 型分类能较全面地反映这一一疾患的特征和各病种的特性。可以明确各 病种的治疗靶点，较好地指导手术和栓塞治疗。并通过对脊髓血管的 功能解剖的深入理解。改进治疗手段，有助于提高解剖治愈率。本组 的治疗结果优于其它组。本组近期治疗效果优于以往。 关键词：脊柱，脊髓，血管畸形，动静脉畸形，动静脉瘘 ABSTRACTobjective：To ABSTRACT objective：To propose a new modified classification of spinal vascular malformations and to evaluate its significance on clinical application．To access the efficacy and saf．e够of the improved therapeutic techniques on spinal cord vascular malformations Material and Methods：Siuce 1986 to March 2003，we had treated 549 cases of spinal vascular malformations．All the cases were divided into its category of the new classification．Thorough overview Was made on sex，age，location，history,development，treatment，clinical and anatomical results．Quantified functional scales were applied on the therapeutic results in detail．The therapeutic methods had been improved in the period of 2000-March，2003，according to the modified classification．The results in this period weTe statistically compared with the previous ones． Results：The new classification includes all spinal vascular lesions in our group．With the treatment．82．2％of spinal vascular malformations cases were improved．62．6％cases have got 95％～1 00％ anatomical elimination results．With the help of the new modified classification and improved therapeutic techniques，the 95％～100％ anatomical elimination results were achieved as 87．2％．without declination of the average functional results in early stage after treatment． Th