脊髓纵裂的CT诊断价值

１９７８－１９９２年共收治脊髓纵裂３９例，其中１７例术前行ＣＴ检查确诊。ＣＴ特征：椎管中央有纵行骨嵴将脊髓或马尾分隔，多数骨嵴两侧蛛网膜下间隙及脊髓不均称；该部柱管扩大；椎体及附件结构紊乱。ＣＴ不仅能准确诊断损害的平面，而且能显示椎管的自然状态和骨嵴的种类及轮廓。     

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。     

脊髓纵裂的CT诊断价值（附17例报告）

１９７８～１９９２年共收治脊髓纵裂３９例，其中１７例术前行ＣＴ检查确诊。ＣＴ特征：椎管中央有纵行骨嵴将脊髓或马尾分隔，多数骨嵴两侧蛛网膜下间隙及脊髓不均称；该部椎管扩大；椎体及附件结构紊乱。ＣＴ不仅能准确诊断损害的平面，而且能显示椎管的自然状态和骨嵴的种类及轮廓。     

儿童脊髓纵裂手术治疗的并发症

目的：研究脊髓纵裂手术并发症，提高手术疗效，提出预防措施。方法：我院自1978年8月至2001年7月手术治疗脊髓纵裂患儿39例，6例出现不同程度并发症，发生脑脊液漏2例、神经损伤3例、硬膜外血肿1例。对6例并发症的原因、时间、治疗、预后、临床表现进行分析。结果：6例并发症产生原因是由于术中硬膜的修补不完善、损伤及牵拉脊髓，止血不严密造成，经治疗预后较好。结论：手术中熟悉脊髓纵裂解剖特点，显微操作，严密止血可避免并发症。     

小儿脊髓纵裂畸形的诊治

目的：探讨少见的小儿脊髓纵裂畸形的诊断和治疗。方法：分析了8年间经影像学检查及手术证实的脊髓纵裂10例，男4例、女6例，年龄1个月～10岁，平均年龄4．5岁。8例行MRI检查，其中3例在病变区加作CT扫描。CT和椎管造影检查各1例。10例中2例拍脊柱X线平片。结果：脊髓纵裂部位：腰骶段2例，腰段7例，下胸段1例。依影像学检查结果，按Pang脊髓纵裂分型：Ⅰ型8例，Ⅱ型2例。9例术后神经功能均有较明显改善，1例生后因腰背部脊髓脊膜膨出，外院手术后左下肢瘫，脊髓纵裂术后无明显改善。结论：影像学检查是明确诊断和术前分型的重要手段。Pang分型反映了脊髓纵裂的特征。按分型制定治疗方案，Ⅰ型应及早手术，切除骨嵴，修整硬膜囊，解除脊髓栓系等。Ⅱ型是否手术视情况而定。     

脊髓纵裂诊治中的常见问题及对策

脊髓纵裂是一种神经管畸形,表现为脊髓中间出现异常的骨性、纤维软骨性或纤维分隔物,将脊髓节段性分为左右两部分,造成脊髓被分隔物卡压、限制和牵拉,进而导致脊髓拴系症状。手术是脊髓纵裂唯一有效的治疗方法,一经确诊应尽早手术。手术原则:切除纵裂脊髓间的骨性分隔物及所有软组织,去除所有拴系因素。同时,要尽量避免手术并发症,并注意保留脊椎小关节和维持脊柱稳定性。本文旨在阐述脊髓纵裂畸形诊治中的常见问题及对策,为提高诊治正确率、有效率,减少手术并发症提供参考。     

Ⅰ期手术治疗脊髓纵裂合并脊髓栓系综合征

脊髓纵裂畸形（split cord realformation，SCM）为较少见的脊髓发育畸形，常伴有脊髓栓系而导致双下肢发育不良、感觉减退、甚至大小便失禁等多种神经功能障碍。我院自1999年8月至2004年2月共收治12例脊髓纵裂合并脊髓栓系综合征患儿，均采用Ⅰ期手术治疗，术后随访3个月～4年，效果良好。     

小儿脊髓纵裂诊治的进展

脊髓纵裂（Diastematomyelia）是一种少见的先天性脊髓畸形。这种畸形是以“脊髓被间隔在矢状面上呈节段性分开”为特点[１]，且多伴背部皮肤异常、脊柱畸形、（脊髓）脊膜膨出、脊髓栓系等，间隔可以由纤维组织、软骨、骨组织或者上述几种成份组成[２]。出生后脊髓的发育持续受到畸形椎骨、纤维束带的限制，临床神经症状往往逐渐加重[３]，严重危害着小儿的生长发育。近年来，随着影像学的不断发展，给临床诊断和治疗提供了很大的帮助，手术是目前唯一的治疗方法，现将小儿脊髓纵裂的诊治进展作一综述。１概述脊髓纵裂的命名目前不统一，…     

先天性脊柱侧弯并脊髓纵裂畸形48例

目的探讨小儿先天性脊柱侧弯(CS)并脊髓纵裂畸形(SCM)的临床特征及脊椎畸形和SCM的相关性,以指导临床治疗方案的选择。方法回顾性分析48例CS并SCM患儿的临床资料,按就诊时是否存在临床症状将患儿分为2组,患儿均行全脊柱MRI、CT扫描,尿流动力学和双下肢肌电图检查,并根据影像学检查结果,依据Winter和Pang分型分别对CS和SCM进行临床分型,将所得常规体格检查及影像学检查资料进行分析。结果在48例CS并SCM的患儿中Ⅰ型SCM 31例(64.6%),Ⅱ型17例(35.4%);CSⅠ型(形成障碍)11例(22.9%),Ⅱ型(分节障碍)10例(20.8%),混合型27例(56.3%)。患儿就诊时存在背部中线处皮肤异常26例(54.2%)例,双下肢形态和(或)肌力不对称29例(60.4%),尿流动力学检查异常38例(79.2%)。结论小儿CS并SCM以胸段、胸腰段Ⅰ型骨性纵裂常见,且多见于混合障碍型侧弯。临床特征主要表现为腰背部中线处皮肤异常、双下肢外观及肌力不对称和大小便功能异常。此类患儿一旦确诊,在侧弯矫正前均应对SCM进行预防性处理。     

小儿脊髓纵裂诊疗分析

目的探讨小儿脊髓纵裂的临床特点及治疗方法。方法回顾性分析2001年1月至2011年5月作者收治的9例脊髓纵裂患儿临床资料,年龄2个月至6岁,平均年龄17个月。出现症状时间平均7个月。临床表现有背侧中线皮肤病损7例,脊柱畸形4例,下肢功能障碍及畸形4例,排尿障碍6例,排便障碍5例,下肢疼痛1例。6例术前经CT或MRI检查确诊,3例为术中发现。Pang分型：Ⅰ型6例,Ⅱ型3例。所有病例均合并终丝栓系,合并其它脊髓畸形6例,包括脊髓脊膜膨出2例,脊髓脂肪瘤3例,皮样囊肿1例。所有病例均行手术治疗,切除脊髓分隔,同时解除合并的其它脊髓栓系畸形。结果9例患儿中,5例痊愈,所有神经症状消失,3例显著改善,1例好转,无症状加重及无效病例。结论小儿脊髓纵裂多合并其它脊髓畸形,临床表现不典型。早期诊断、早期治疗是提高疗效的关键。     

Utility of multidetector CT and virtual bronchoscopy in tracheobronchial obstruction in children

Purpose: The aim of this study was to evaluate the potential use of multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation of tracheobronchial patency in children with suspected bronchial obstruction and to compare its findings with fibreoptic/rigid bronchoscopy or surgery. Patients and methods: A total of 43 children (15 girls, 28 boys) with clinically suspected bronchial obstruction underwent contrast enhanced MDCT, using an age‐ and weight‐ adjusted low dose protocol. Post‐processing was performed and VB and multiplanar reformations (MPR) were obtained at the same sitting. Findings obtained at MDCT and VB were compared with fibreoptic/rigid bronchoscopy and surgery. Results: Obstructive pathology was found in 26 children, which included endoluminal foreign body, mucus plugs in 13 children, endobronchial tumour in three children and extrinsic compression (lymph node, aberrant Vessels, mediastinal cysts/tumours) of the tracheobronchial tree in 10 children. In 17 children, no obstructive lesion was identified. Excellent positive correlation was obtained, between MDCT‐VB and bronchoscopy/surgery, however, in one child with endobronchial obstruction caused by tracheitis, low dose MDCT‐VB was normal, but bronchoscopy revealed granularity and plaques. Conclusion: MDCT‐Virtual bronchoscopy is useful in evaluating bronchial stenosis and obstruction caused by both endoluminal pathology and external compression and has the advantage of looking beyond stenosis. Its main application lies in providing the exact location of suspected foreign body, prior to bronchoscopy. However, it fails to disclose exact nature of obstructing pathology.     

肺CT在诊断和治疗小儿气管、支气管异物中的价值

目的 探讨肺CT在诊断和治疗小儿气管、支气管异物中的价值.方法 对怀疑气管、支气管异物的45例患儿进行肺CT检查,应用的是16层超薄CT扫描,条件为:100～150 kV,30～50 mA,层厚1 mm,CT扫描后进行多层CT影像重建.结果 45例患儿中有42例CT检查发现了异物,另外没发现异物的3例经抗生素对症治疗1周痊愈,避免了支气管镜检术.根据CT影像及异物特点,我们设计了手术方案并选择合适的异物钳,42例患儿均一次即将异物取出,肺CT所显示的异物位置、形状及体积与支气管镜检时所见基本一致.结论 应用肺CT可以准确地诊断出气管、支气管异物,CT所提示的异物位置、形状、体积对于设计手术方案和安全取出异物具有重要价值.     

CT in the staging of children with malignant tumours

The application of CT whole-body scanning as an adjunct in the staging investigations was evaluated in 56 children with various types of extracranial solid malignant tumours. CT proved to be superior to conventional films in the detection of pulmonary or pleural dissimination. The abdominal lymph nodes were difficult to evaluate by CT, and abnormal nodes could only be diagnosed when they were unequivocally enlarged. The role of CT in the detection of liver metastases could not be established in this study due to the rare occurrence of liver involvement. CT seemed to be a valuable method in the prediction of the operability of the primary tumour, but seemed to have an inability to show local invasiveness of the tumour.CT is an important supplement to conventional, noninvasive methods in the staging of these patients because CT is able to detect otherwise undetectable dissimination and this results in an improved therapeutic approach in individual cases.     

The clinical value of CT whole-body scanning in pediatric tumour investigation

The results of 100 consecutive CT whole-body scans in children with suspicion of a tumour and possible malignancy have been analysed. The final diagnoses were these: a tumour in 40 patients; non-tumoural lesions such as cysts, abscesses or malformations in 22; various medical conditions in 30 cases; and no abnormality in eight. The suspicion of malignancy was confirmed in 36 patients. CT proved to be an accurate method in the diagnosing and differentiation between solid or predominantly solid tumours and various non-tumoural lesions. The clinical value of CT was assessed by comparing the information from CT with those obtained by routine clinical and other radilogical means. CT was positive informative in 57% of the patients and correctly excluding a tumour in 28%. CT was either non contributory or misleading in 15%. Finally, the quality of the scans were evaluated and the specific problems related to pediatric CT are discussed.     

Correlation Between Pathologic and Ultrasound Findings in First Trimester Spontaneous Abortions

We compared the pathologic and ultrasonographic findings of 31 first trimester spontaneous abortions to determine the benefits of such studies. The ultrasound diagnoses included empty gestational sac (n = 11), intrauterine fetal death (n = 11), abortion in progress or incomplete abortion (n = 8), and live embryo (n = 1). Two subgroups of empty sacs were identified by pathologic examination. Embryonic development appeared to be more advanced in one group as indicated by the presence of embryonic red blood cells (RBC's) in the placental vessels. Although an embryo or fetus was identified more frequently by sonar than by pathologic examination, we were able to diagnose developmental anomalies in small embryos that current ultrasound equipment cannot resolve. Such anomalies were identified even in the presence of fetal heart activity. Pathologic examination was also informative when heavy bleeding obscured the contents of the uterine cavity to sonar and was thus supplementary of a suboptimal ultrasound examination. Placental examination proved to be reliable in assessing gestational age at the time of embryonic/fetal death. There was a good correlation between RBC morphology and sonographic measurement of crown-rump length. First trimester ultrasound and pathologic examination of the embryo and placenta are informative and complement each other.     

联合头颅CT和甘露醇后腰穿测压的小儿降颅压方案的可行性探讨

目的探讨临床上简便易行而有效的控制颅高压方案,即本文提出的联合应用头颅CT和甘露醇后腰穿测压的降颅压方案的可行性分析。方法将42例Glasgow<8分颅高压患儿分为经验性降颅压组(经验组)26例和联合头颅CT和甘露醇后腰穿测压组(新方案组)16例,比较两组的Glasgow评分、甘露醇用法、预后等。结果两组患儿的年龄、Glasgow评分、尿素氮、肌酐、平均动脉压、血钠、PCO2无明显差异,而两组甘露醇用法有显著性差异(χ2=25.321,P<0.001),结果两组死亡、好转、恶化、发生脑疝病例数明显不同(χ2=24.44,P<0.001)。结论联合应用头颅CT和甘露醇后腰穿测压的降颅压方案简便易行而有效。