胎儿终丝形态学及光镜研究

目的 观察正常胎儿终丝形态及其结构,为研究脊髓栓系综合征患儿的终丝结构提供参照标准.方法 测量并切除10例新鲜流产胎儿终丝,取其纵、横切面行光镜观察.结果 终丝由1～5μm直径的弹簧样纵向胶原纤维束组成,纤维束呈层分布,每层之间有空隙;层内纤维束之间也有空隙.层间隙、束间隙及束内每根纤维问由横向精细网状纤维连结,也可见到胶原纤维束交叉连结各束间及层问纤维.弹性纤维分散在胶原纤维束内或集中排列在胶原纤维束间.间隙可见少量毛细血管.结论 终丝的结构及成分改变可能与脊髓栓系综合征的发病密切相关.     

类似腰椎间盘突出的成人脂肪型脊髓栓系综合征1例

患者,男,22岁,因左下肢放射痛伴麻痹无力2个月于2019年7月23日入院就诊.查体:轻度左下肢跛行,无腰痛,左下肢T12水平以下皮肤痛觉减退,左下肢股四头肌肌力4 级,直腿抬高试验阴性,病理反射未引出,膝、踝反射存在.腰椎X 线片显示腰椎骨质未见异常.腰椎CT 显示:① L4～5椎间盘轻度膨隆,L5 ～S1 椎间盘轻...     

圆锥位置正常型脊髓栓系综合征病例分析与诊断的再审视

背景:脊髓栓系综合征(TCS)的病因是脊髓和神经被牵拉,随后出现下肢感觉、运动和/或膀胱、肛门括约肌功能障碍。近年来的研究发现圆锥位置正常,即圆锥位于腰2椎体下缘以上的TCS,但由于这类TCS发病隐匿,诊断困难,常被漏诊误诊。目的:对圆锥位置正常型脊髓栓系综合征的病例进行统计分析,明确其发病特点,以期帮助临床医师对TCS更加深刻的理解并及时对TCS进行诊断,减少误诊漏诊。方法:检索并阅读1956年8月至2017年7月PubMed数据库所有TCS相关英文全文文献,共纳入127篇文献,341例TCS病例,其中记录圆锥位置的有208例。仔细阅读文献,记录TCS患者的基本资料、圆锥位置、临床表现,通过SPSS软件对圆锥位置正常和低位圆锥型TCS病例的临床资料进行统计分析。结果:341例TCS病例中记录圆锥位置208例(61.0%),其中圆锥位置正常型36例(17.3%),低位圆锥型172例(82.7%)。36例圆锥位置正常型TCS病例中脂肪瘤浸润、终丝变性、脊柱裂是前3位病因;172例圆锥低位型TCS病例中脂肪瘤浸润、椎管内术后、终丝变性是前3位病因。由脊髓纵裂引起的圆锥位置正常型TCS病例数明显多于圆锥低位型TCS病例数(P=0.020)。二者在脂肪瘤、非脂肪瘤性肿块、酒窝样凹陷、多毛、皮窦、皮赘、皮肤色素沉着、腰骶部尾样结构、疼痛、鞍区感觉异常、下肢功能异常、大小便功能异常及膝反射和肛门反射异常等没有明显的统计学差异。圆锥位置正常TCS病例中腰骶部血管瘤病例(11.1%)明显多于圆锥低位TCS病例(0.6%, P=0.003);圆锥低位型TCS下肢感觉异常的病例(44.8%)明显多于圆锥正常位置型TCS的病例(19.4%,P=0.005);圆锥低位型TCS跟腱反射亢进的病例(2.3%)明显少于圆锥正常位置型TCS的病例(13.9%,P=0.009);圆锥低位型TCS跟腱反射减弱的病例(19.2%)明显多于圆锥正常位置型TCS的病例(5.6%)(P=0.047)。结论:对于表现为TCS的病例,且圆锥位置正常,但又不存在腰椎间盘突出、腰椎管狭窄、腰椎滑脱等退变性疾病的病例,应该高度怀疑TCS的可能性,需要行尿流动力学检查、俯卧位腰椎MRI检查、双下肢神经电生理等辅助检查,明确是否是圆锥位置正常型TCS。     

脊髓终丝室管膜瘤1例报告

患者女性,５５岁,因腰骶部疼痛２个月,伴右下肢轻度麻痛于２０００年４月入院,疼痛以隐痛为主,休息后无好转,夜间疼痛加重,无跛行。门诊查腰椎ＣＴ发现椎管内占位性病变。查体：脊柱生理弯曲正常,无侧弯,活动正常,第五腰椎棘突轻压痛、叩痛,无放散,骶尾部皮肤感觉过敏,右小腿前外侧及足背感觉略迟钝,双下肢肌力及足背伸力正常,直腿抬高加强试验阴性,病理反射阴性。辅助检查：三大常规、肝肾功能及血沉结果均正确;Ｘ线片：腰椎退行性变。ＣＴ片：椎管内占位性病变,脂肪瘤可能,腰５～骶１椎间盘轻度膨出。ＭＲＩ片：脊髓终…     

脊髓终丝室管膜瘤1例报道

患者女性 ,36岁。因腰痛伴左下肢麻木半年 ,加重半个月 ,于 2 0 0 0年 11月2 7日以“腰椎间盘突出症”收入推拿病房 ,后以“脊髓肿瘤”转入骨科病房。半年前因受凉而引起腰痛 ,左下肢放射痛 ,经推拿、牵引治疗后症状减轻 ,半个月前因劳累加重 ,给予硬脊膜外注射 0 2 5 %普鲁卡因与布比卡因 (5 :1)两次 ,疼痛反而加重 ,不能行走及坐立 ,大小便正常。查体见 :强迫平卧位 ,脊柱无明显侧弯 ,Ｌ2棘突叩击痛 ( ) ,双直腿抬高试验(- ) ,加强试验 (- ) ,“4”字试验 (- )。双下肢浅感觉正常 ,左侧臀部感觉麻木 ,右跟腱反射减退 ,背伸肌力右侧稍弱…     

大鼠改良脊髓栓系综合征模型的建立及评估

目的探讨SD大鼠改良脊髓栓系综合征模型的有效性和可靠性。方法 2020年9月在新疆医科大学第一附属医院选取清洁级SD大鼠60只, 按照体重随机分为实验组和对照组, 每组各30只, 实验组采用改良慢性牵拉法建立大鼠脊髓栓系综合征模型。分别检测大鼠后肢行为学功能、膀胱功能、运动诱发电位及脊髓病理生理变化, 应用SPSS 20.0软件进行分析。结果实验组大鼠术后7 d残余尿量为(1.94±0.23) ml, 明显高于对照组[(0.18±0.16) ml, t=3.886, P<0.05], 术后30 d实验组大鼠出现严重的膀胱功能障碍[(2.92±0.32) ml], 明显高于对照组[(0.19±0.21) ml, t=7.542, P<0.05]。同时, 与对照组比较, 实验组大鼠Tarlov评分降低, 运动诱发电位(MEP)中的P波潜伏期延长、波幅下降(χ2=4.876, t=3.468, P<0.05);病理检测发现, 脊髓末端组织观察到不同程度的神经细胞坏死、胞浆内尼氏体淡然, 数量明显减少并分布不均匀。结论 SD大鼠改良脊髓栓系综合征模型为脊髓栓系综合征的基础及临...     

脊髓纵裂患者脊髓栓系综合征的手术疗效分析

目的分忻双管型脊髓纵裂患者脊髓栓系综合征的手术疗效。方法对34例行手术治疗的双管型脊髓纵裂TCS患者进行回顾性分析。结果通过手术后观察和3个月～5年的随访发现．手术的总有率可达91％，尤其是疼痛为主诉的患者恢复最为明显，术后恢复似乎与术前病程无关。结论双管型脊髓纵裂合并TCS的患者一旦确诊．无手术禁忌证就应尽早手术。只要手术操作细致，大多患者症状可缓解．不会出现明显的神经并发症。     

成人脊髓栓系综合征的显微手术治疗--附8例临床分析

目的：探讨成人脊髓栓系综合征(TCS)的临床特点和显微手术治疗效果。方法：回顾性分析了8例成人TCS的诊断情况和显微手术治疗的效果。结果：本组病例从发病到确诊最长时间为33年，最短4年，平均26年。手术对疼痛症状的效果明显，运动感觉功能的效果欠佳，最差的是泌尿系统症状，所有病例神经功能损害未再进一步加重。结论：TCS的早期诊断和手术是提高疗效的关键，而术中应用显微外科技术是保证手术成功、提高手术效果和防止再栓系的有力手段。     

脊髓栓系综合征病因的研究进展

脊髓圆锥受到牵拉导致脊髓栓系综合征的理论已经存在数十年,但随着近几年的研究,表明脊髓栓系综合征并不只存在脊髓圆锥的牵拉损伤,还包括马尾神经和周围神经根的牵拉损伤,其病因的研究也就成为热点,目前研究表明其病因主要包括基因和染色体的异常、胚胎发育的异常、后天原因等。     

脊髓纵裂合并脊髓栓系综合征的治疗

目的：分析双管型脊髓纵裂患者脊髓栓系综合征的手术治疗效果。方法：对34例行手术治疗的双管型脊髓纵裂TCS患者进行回顾性分析。结果：通过手术后观察和3个月～5年的随访发现,手术的总有效率可达91％,尤其是疼痛为主诉的患者恢复最为明显,术后恢复似乎与术前病程无关。结论：双管型脊髓纵裂合并TCS的患者一旦确诊,无手术禁忌症就应尽早手术。只要手术操作细致,大多患者症状可缓解,不会出现明显的神经并发症。     

Ganglioglioma of conus medullaris

Summary Gangliogliomas are glioneuronal tumours of the young, and occur more frequently supratentorially. Among those uncommon cases in the spinal cord, the conus medullaris is an extremely rare site. We reviewed the literature of such cases and report another case of a ganglioglioma of the conus in a 13-year-old boy with an insidious sensory sensitive and motor deficit of the right lower limb. Subtotal resection was accomplished with no recurrence after two years of follow-up. As for the supratentorial locations, the extent of surgical resection is the main prognostic factor for gangliogliomas of the spinal cord, and they should be considered in the differential diagnosis of intramedullar neoplasm.     

脊髓圆锥末端位置与蛛网膜下腔阻滞引起脊髓损伤的关系

国内外很多学者通过核磁共振观察统计脊髓圓锥末端位置的水平,发现其变化范围为T_(12)-L_3椎体,并与年龄、性别、体位、脊髓发育异常等多方面因素有关,而蛛网膜下腔阻滞时常选择L_2/L_3间隙穿刺,此法会增加脊髓损伤的风险并且有明确病例报道并提供了直接证据.蛛网膜下腔阻滞引起脊髓损伤与定位不准、穿刺针因素、穿刺技术和脊髓解剖位置有关.了解脊髓圆锥末端的位置与蛛网膜下腔阻滞的关系对于避免和预防脊髓损伤尤为重要.     

Ganglioglioma of conus medullaris: A case report

A case of a ganglioglioma of the conus medullaris extending between T-12 and L2 segments is reported. The tumor was succesfully removed by third stage operation. Ganglioglioma located in the conus medullaris is extremely rare. The best treatment of spinal cord ganglioglioma is totally tumor excision even when multiple stage operations are necessary.     

Syrinx of the conus medullaris and filum terminale in association with multiple hemangioblastomas

A patient with multiple hemangioblastomas and syrinxes of the cerebellum and spinal cord is presented. An additional mass imaged at the L-3 vertebral level was identified by percutaneous syringography as a bilobular syrinx extending from the conus medullaris into the filum terminale. At surgery the syrinx was opened into the caudal cerebrospinal fluid space and the several hemangioblastomas excised. These spinal tumors all appeared to arise in juxtaposition to the posterolateral sulcus and dorsal sensory roots.     

Damage to the conus medullaris following spinal anaesthesia

Seven cases are described in which neurological damage followed spinal or combined spinal-epidural anaesthesia using an atraumatic spinal needle. All patients were women, six obstetric and one surgical. All experienced pain during insertion of the needle, which was usually believed to be introduced at the L2-3 interspace. In all cases, there was free flow of cerebrospinal fluid before spinal injection. There was one patchy block but, in the rest, anaesthesia was successful. Unilateral sensory loss at the levels of L4-S1 (and sometimes pain) persisted in all patients; there was foot drop in six and urinary symptoms in three. Magnetic resonance imaging showed a spinal cord of normal length with a syrinx in the conus (n = 6) on the same side as both the persisting clinical deficit and the symptoms that had occurred at insertion of the needle. The tip of the conus usually lies at L1-2, although it may extend further. Tuffier's line is an unreliable method of identifying the lumbar interspaces, and anaesthetists commonly select a space that is one or more segments higher than they assume. Because of these sources of error, anaesthetists need to relearn the rule that a spinal needle should not be inserted above L3.     

Spontaneous conus medullaris infarction in a 79 year-old female with cardiovascular risk factors: a case report

Objective:

To detail the case of a 79 year-old female who presented with sudden bilateral neurological deficits of the lower extremities and was later diagnosed with non-traumatic conus medullaris infarction. The purpose of this case report is to inform primary contact practitioners of the presentation, diagnosis and the associated risk factors of this condition in order to facilitate prompt management.

Clinical Features:

Spinal cord infarction presenting as low back pain with a high degree of bilateral loss of motor strength, sensation and reflexes in the lower extremities and bowel/bladder dysfunction, in a patient with previous coronary artery bypass graft surgery and renal insufficiency.

Intervention and Outcome:

Referral to emergency within hours of symptom onset allowed for immediate assessment, management and relatively favourable partial recovery.

Summary:

Although rare, conus medullaris infarction is potentially devastating and requires an appropriate clinical index of suspicion for timely diagnosis, treatment and optimal neurological recovery.     

The conus medullaris ratio: A new way to identify tethered cord on MRI

Purpose

Approximately 25% of patients with anorectal malformation have tethered cord. The traditional way of determining conus medullaris level on magnetic resonance imaging (MRI) relies on counting vertebrae, which may be challenging due to vertebral numeric variation, segmentation anomalies, as well as transitional vertebral body anatomy. The purpose of this study was to utilize more reliable anatomic landmarks (foramen magnum, conus termination, and the upper limit of the iliac crest) to establish a consistent ratio that may differentiate patients with normal and low-lying conus.

脊髓,圆锥与马尾损伤分类：附106例胸腰段脊柱与脊髓损伤分析

本文将１０６例胸１０到腰４的脊柱脊髓损伤的病例进行神经损伤的分类：Ｉ型：完全性脊髓损伤；Ⅱ型：完全性脊髓－圆锥损伤；Ⅲ型：不完全性圆锥马尾损伤；Ⅳ型：完全性圆锥损伤，合并部分马尾损伤：Ⅴ型：完全性圆锥马尾损伤；Ⅵ型：单纯圆锥损伤；Ⅶ型：部分马尾损伤．文章论述了每一型损伤的诊断标准，讨论了分类的意义，神经损伤与膀眈功能分级的关系；提出了以感觉、运动及膀胱功能为指标的截瘫量化功能评价的格式．