脊髓纵裂的CT影像与手术所见的关系

目的：通过研究脊髓纵裂的ＣＴ影像与手术所见的关系，评价ＣＴ扫描的诊断价值，揭示ＣＴ扫描在手术治疗、提高手术疗效及神经缺陷发生机制中的重要作用。方法：根据ＣＴ扫描影像与手术中所见的病理改变，对２３例进行对比研究。结果：根据ＣＴ影像与手术所见将脊髓纵裂间隔分为骨性、软骨性、纤维性和混合性。２０例患儿２３处脊髓纵裂中，骨性１８例，软骨性２例，纤维性１例，混合性２例，除１例纤维性间隔ＣＴ平扫未能显示外，其余的ＣＴ影像与手术所见相符。结论：ＣＴ平扫影像与手术中所见相符。ＣＴ扫描是脊髓纵裂理想的、有价值的诊断手段，给临床提供了清晰的病变图像，为手术的正确操作奠定了良好的基础，为研究神经缺陷的发生机制提供了重要依据。     

胎儿期脊髓纵裂的超声学特征

目的 探讨胎儿期脊髓纵裂的声像图特征.方法 对产后证实的38例脊髓纵裂胎儿的临床资料进行回顾性分析,探讨脊髓纵裂的产前超声表现特征、发生部位、合并畸形及妊娠结局.结果 在38例脊髓纵裂的患儿中,其病变部位的椎管内均可见形状各异的高回声,局部脊髓均受压,相对应的椎弓板间距明显增宽,病变部位位于腰、骶部时,均合并脊髓圆锥下移,超声诊断的灵敏度高.结论 胎儿期脊髓纵裂具有特征性超声表现,在产前可以通过超声筛查检出.     

脊髓纵裂的手术疗效观察

收治脊髓纵裂４６例，其中２９例作神经功能状态的临床评价及胫后神经皮层体感诱发电位检查。结果：非手术组随访后神经功能缺陷无改善（Ｐ＞０．０５）；２０例手术组神经功能的临床评分明显增加及胫后神经皮层体感诱发电位明显改善（Ｐ＜０．０５）。表明手术不仅可阻止神经功能缺陷的发展，而且可使其得到改善，是一有效的治疗手段。     

Klinik und Differentialdiagnose der cranialen Migrationshemmung des Rückenmarks

Zusammenfassung Nach einer Literatur-und pathomorphologischen Übersicht wird an Hand von 23 Fällen einer spinalen Malformation unterschiedlicher Genese das klinische Bild der cranialen Migrationshemmung herausgearbeitet. Für die Diagnose ist neben Hautveränderungen über der dorsalen Mittellinie, wie sie für den dysrhaphischen Formenkreis typisch sind, die neurologische Symptomatik der unteren Extremitäten richtungweisen. Der Beweis einer Aszensionshemmung kann nur durch die Myelographie erbracht werden. Die Bedeutung frühzeitiger operativer Maßnahmen zur Verhinderung progredienter Ausfälle wird besonders herausgestellt.

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Clinical features and differential diagnosis of the restricted cranial migration of the spinal cord

After a review of the literature on, and the pathology of spinal malformations the clinical features of a restricted ascent of the spinal cord are described with reference to 23 cases of spinal dysrhaphism of varying genesis. The suppression of cranial migration is caused either by a diastematomyelia, a lipoma, or a dermoid sinus with direct connection to the spinal cord, or else by myelomeningoceles and cicatrices after arachnitis.The symptoms occur particularly during the early years of life and in the age group of between 20 and 30.The manifestations of the disease are changes over the dorsal midline which are typical for spinal dysraphism, neurological defects of the lower limbs, and abnormalities in the function of bladder and rectum. Deformations of the feet and trophic disturbances have been encountered.Important for the diagnosis is a radiographic investigation of the spine since a restriction of the cranial migration can only be proved by myelography. Operation with view of a release of the spinal cord is the method of choice. The importance of early operative measures for the prevention of progredient deficiencies is particularly stressed.

     

Primary lumbosacral Wilms tumor associated with diastematomyelia and occult spinal dysraphism

Background The occurrence of an extrarenal Wilms tumor in the lumbosacral region is an extremely uncommon condition.Case report We report a case of Wilms tumor in the lumbosacral region that was associated with diastematomyelia and occult spina bifida. An 18-month-old girl presented with a swelling over the lower back with a tuft of hair on it, which she had had since birth. Imaging of the spine revealed spina bifida, bony diastematomyelia, and tethered cord. Excision of the bony spur and detethering of the cord was done. After a year, she had recurrence of swelling at the same site, weakness of both lower limbs, and incontinence of bladder and bowel. Excision of the mass and bony spur and detethering of the spinal cord were done. Histopathological examination showed features of a Wilms tumor.     

脊髓纵裂的CT影像与手术所见的关系

本文对２０例脊髓纵裂患者的ＣＴ图像与手术中所见进行对比分析，其ＣＴ图像和手术所见基本相符。据ＣＴ和手术所见，将脊髓纵裂间隔分为骨性、软骨性、纤维性和混合性。本文就ＣＴ平扫图像对脊髓纵裂的诊断、ＣＴ平扫图像和手术中所见在研究神经缺陷发生机制中的作用及各类型间隔的ＣＴ表现和术中所见加以讨论。     

Scoliosis circa 2000: radiologic imaging perspective

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming nonidiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.     

Cervical diastematomyelia and syringohydromyelia in a myelomeningocele patient

A case of cervical diastematomyelia and syringohydromyelia in a 16-year-old female myelomeningocele patient is reported. Progressive weakness of the upper extremity led to an MR examination of the brain and spine, which revealed hydrocephalus, Chiari II malformation, cervical diastematomyelia with a syringohydromyelic cavity in each hemicord and a large dural sac in the lumbar region. Operative therapy consisted of detethering and shunting of the two syringes. Soon after surgery her symptoms improved. The need for early complete MR imaging of myelomeningocele patients presenting with new symptoms is emphasized. Received 20 March 1996; Revision received 30 May 1996; Accepted 10 July 1996     

Importance of early radiologic diagnosis of congenital anomalies of the spine

Manifest or occult spinal dysraphism in the absence of neurological symptoms is likely to remain undetected. Therefore, accurate and early diagnosis of such underlying anomalies is of prime importance for early surgical intervention in order to avoid late irreparable damage. During a period of just over 1 year, 17 such cases of spinal congenital anomalies were diagnosed by myelography with metrizamide and computed tomography-myelography. There were 16 cases of tethered cord, six with myelomeningocele, two with diastematomyelia, two with a split spinal cord, three with a lipoma, and the remaining three with vertebral anomalies. Scoliosis was present in 60%, weakness of both legs in 45%, and asymmetry of the feet in 25%. Some of these patients were initially brought to the orthopedic department for corrective surgery before undergoing a complete neurological evaluation; thus the radiologist was acting as the link between patient and neurosurgeon. Clinical experience has shown that surgical treatment can be successful and can thereby obviate further progression of neurological symptoms.     

螺旋CT容积再现技术在椎管内骨嵴形态学研究中的应用

目的:显示椎管内骨嵴三维立体结构,测量其大小、形态。方法:63例脊髓纵裂合并椎管内骨嵴患者行螺旋CT容积扫描,共发现79个骨嵴,将其原始数据减薄行容积再现技术(volume rendering technique,VRT)重建。结果:骨嵴可分为不分叉型及分叉型,不分叉型65个,分叉型14个,不分叉型明显多于分叉型(P<0.05);不分叉型有多种形态,在胸腰段形态多为前后粗中间细前端径线大于后端径线且前中部上下径大于宽径形(P<0.05);上腰段骨嵴前端宽径明显大于其它节段(P<0.05);分叉型多为后方分叉型,总共14个分叉型中有7个位于腰1节段。结论:VRT图像可以清晰显示椎管内骨嵴的三维解剖学形态,其在椎管内骨嵴诊断及术前评估中具有重要的应用价值。