外伤性颈脊髓中央综合征手术治疗

目的总结早期手术治疗颈脊髓损伤中央综合征的临床效果和经验,探讨早期手术治疗的积极意义。方法选择2005年以来颈脊髓急性损伤患者确诊为颈脊髓中央综合征的病例中采用手术治疗的22例患者,其中男15例,女7例;年龄22～70岁,平均46岁。入院时间为伤后1 h～2周。损伤原因：车祸伤11例,平地摔伤6例,高处坠落伤3例,重物砸伤2例。损伤分型为：过伸性损伤15例,甩鞭样损伤5例,垂直压缩损伤2例;X线片提示6例颈椎骨折并半脱位,颈椎不稳;16例无明显骨折脱位型,进一步MRI检查提示单纯颈椎间盘突出7例,合并椎管狭窄9例,MRI检查22例均有颈脊髓信号异常;单纯上肢型5例,四肢型17例;脊髓损伤分级按Frankel分级,B级3例,C级11例,D级8例。随访时间6个月～4年,平均18个月。针对颈髓压迫位置,手术方式分别采用颈椎前/后路椎管减压、植骨融合并行内固定手术,经颈前路手术16例,经颈后路内固定5例,1例行单纯颈后路椎管半开门扩大成形术。伤后距离手术时间4～16 d,平均7 d。结果 22例患者均获满意疗效,脊髓压迫改善,神经功能均有明显恢复,病人神经刺激症状术后就有改善,四肢肌力及大小便功能随后开始恢复,Frankel法评定优良率为77%。结论对于脊髓损伤的中央综合征患者,早期进行椎管减压、稳定脊柱等手术干预治疗可有效减轻脊髓水肿和继发性损伤,缩短病理性炎症反应过程,促进脊髓功能恢复,降低病残率。     

A Case of Central Cord Syndrome Caused by Intubation: A Case Report

Abstract

Following intubation for respiratory distress, a 42 year-old female patient sustained a hyperextension injury which produced a central cord syndrome. This paper illustrates an unusual mechanism whereby a central cord syndrome was caused by pure hyperextension without high velocity force. (J Spinal Cord Med 1997; 20:230-232)     

急性颈髓中央损伤综合征：附17例报告

１９８０～１９９２年共收治１７例急性颈髓中央损伤综合征，占同期颈髓损伤的７，９％，１２例为颈椎过伸性损伤，２例为屈曲性损伤所致、不详３例；其临床特点是上肢瘫重于下肢，１６例有排尿功能障碍；１５例Ｘ线拍片未见骨折和脱位征象。平均住院２４．４天，非手术治疗效果明显。神经功能均有明显恢复。随访结果：四肢瘫巳恢复，仅５例手内在肌萎缩。     

脊髓栓系综合征诊断及显微手术治疗

目的 探讨小儿脊髓栓系综合征(TCS)的诊断及治疗。方法 对收治的TCS患儿52例,从临床表现、手术方法及疗效方面进行分析。结果 圆锥位置与B型超声、MRI一致,椎管内脂肪瘤皮样囊肿等与MRI一致。采用显微手术脊髓栓系松解治疗并不断改进手术方法,可提高疗效,减少并发症。结论 B超、MRI是检查诊断TCS的最好方法。显微外科手术松解脊髓及神经能使大部分TCS患儿症状减轻或治愈。改进手术方法可提高疗效,减少并发症。     

Video urodynamic findings in men with the central cord syndrome

PURPOSE: The central cord syndrome reportedly has a favorable prognosis and rehabilitation outcome. However, to our knowledge the status of the lower urinary tract in patients with the central cord syndrome is unclear. We report on 22 men with the central cord syndrome who were evaluated by video urodynamics. MATERIALS AND METHODS: From 1986 to the present we identified 22 men with a mean age of 51 years who had the central cord syndrome and were included in the Houston Veterans Affairs spinal cord registry. All patients underwent video urodynamic evaluation a mean of 34.5 months after injury. RESULTS: Video urodynamic testing for vesicourethral dysfunction was normal in 3 patients, while it showed bladder outlet obstruction secondary to benign prostatic hyperplasia in 2, detrusor areflexia in 4, external detrusor-sphincter dyssynergia in 11, detrusor hyperreflexia with a synergistic external urethral sphincter in 1 and detrusor hypocontractility in 1. Urinary tract infection recurred in 3 patients with external detrusor-sphincter dyssynergia and urolithiasis developed in 2. CONCLUSIONS: Urodynamic testing revealed a high incidence of external detrusor-sphincter dyssynergia in men with the central cord syndrome. Due to the potential for upper tract deterioration all patients with the central cord syndrome should undergo baseline urodynamic studies. Those at high risk for upper tract deterioration with external detrusor-sphincter dyssynergia or a loss of compliance should be treated more aggressively with clean intermittent catheterization and anticholinergic medication when possible.     

成人脊髓栓系综合征的诊治

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床诊断和治疗。方法回顾性报告１８例成人脊髓栓系综合征的临床资料。所有患者均经ＭＲＩ证实并行手术松解;根据手术所见和影像学分析其致病机理及手术要点。结果脊髓或圆锥的栓系原因各不相同,包括椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月～５年随访,其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ。术中应避免损伤圆锥和马尾神经。病程过长及再栓系是疗效不佳的主要原因。     

Tethered Cord Syndrome in Adults

Summary ? Background. The tethered cord syndrome (TCS) consists of an abnormally low conus medullaris tethered by a thickened filum terminale or various forms of spinal dysraphism. The adult variant of the syndrome seems not to be as rare as once thought.  Method. This study includes 11 patients with a TCS. Clinical, radiological findings and outcome were reviewed in these adult patients with TCS.  Findings. The patients ranged in age from 18 to 34 years (mean 24.09 years). There were 7 men and 4 women. The presenting symptoms in order of frequency were as follows: low back pain radiating to legs, urinary complaints, weakness in legs and impotence. All patients had magnetic resonance imaging scans. Physical exercise in 8, birth delivery in 1 and carrying heavy objects in 1 patient were determined as the precipitating factors. No precipitating factor could be defined in one of the patients. All patients were operated on, except for one. None of the patients worsened after surgery.  Interpretation. The patients presenting with low back pain and sciatica responded to surgery better than those with sphincter problems.     

成人和儿童脊髓栓系综合征的对比分析

目的：分析和比较成人和儿童脊髓栓系综合征(tethered cord syndrome TCS)的临床表现、治疗和预后的异同。方法：对38例儿童和20例成人TCS患者进行回顾性分析。结果：成人TCS病因以硬膜内脂肪瘤为最多见，多以疼痛为主诉，手术对于疼痛、下肢无力和痉挛疗效明显，对大小便功能障碍效果较差；而儿童TCS病因以脊髓脊膜膨出为多见，多因下肢无力就诊，手术对于下肢无力、疼痛和感觉障碍效果较好，对于大小便功能障碍同样效果不理想。结论：儿童和成人TCS在临床表现、预后等方面均有差别，应根据不同患者决定治疗方案。     

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。     

Lower Extremity Compartment Syndrome In An Adolescent With Spinal Cord Injury

Abstract

Objective: Describe the unusual complication of lower extremity compartment syndrome occurring in an adolescent with spinal cord injury (SCI).

Methods: Case presentation.

Results: A 17 -year-old male with C5 ASIA A complete SCI developed a compartment syndrome of his lower leg on the ninth day postinjury. Presenting signs included an equinus deformity of the foot, blackened induration over the anterior tibia, circumferential erythematous markings over the calf, large urticarial lesions over the knee, and calf swelling. The presumed etiology of the compartment syndrome was excessive pressure from elastic wraps, which were placed over gradient elastic stockings. Pressures were 51 mmHg in the superficial posterior; 50 mmHg in the deep posterior; 33 mmHg in the anterior; and 34 mmHg in the peroneal compartments. The patient also developed rhabdomyolysis with myoglobinuria. In addition to supportive care, the patient underwent a dual incision fasciotomy for compartment release.

Conclusions: The development of lower extremity compartment syndrome was probably a result of excessive pressure applied by elastic wraps. Elastic wraps should be used with caution in individuals with SCI.

J Spinal Cord Med. 2001 ;24:278–283     

Urologie Manifestation of Spinal Cord Sarcoidosis

abstract

We present the first report of neurogenic lower urinary tract dysfunction associated with neurosarcoidosis. Urodynamic findings of detrusor hyperreflexia with detrusor-sphincter dyssynergia correlate with this patient’s magnetic resonance imaging (MRI) examination which found intramedullary involvement at the mid-thoracic level. (J Spinal Cord Meet, 19:201–203)     

术中肌电图监测在脊髓栓系综合征手术中应用价值初探

目的探讨术中肌电图监测在脊髓栓系综合征（tethered cord syndrome,TCS）手术中的意义。方法 2010年1月～12月对19例TCS行术中肌电图监测,并使用激发肌电图辨别马尾神经和终丝。记录术中肌电图监测结果及术后新发神经功能障碍。结果术中记录电极在19例下肢骨骼肌和肛门括约肌均监测到爆发肌电和（或）持续性肌电活动,均告知术者予以处理。术后第1天4例出现新发神经功能障碍,术后第10天3例神经功能恢复正常,1例明显改善。19例均使用激发肌电图监测,在没有肌电爆发的部位行终丝切断。结论肌电图监测在TCS手术中可及时发现神经组织受到的牵拉、压迫等机械刺激,通知手术医生调整手术操作后,可能会减少术中医源性损伤的发生。用激发肌电图辨别终丝和马尾神经安全可靠。     

未发现压迫的创伤性非一过性脊髓损伤

未发现压迫原因的非一过性脊髓损伤在脊髓创伤中较为少见。作者1984年至1994年间对423例脊髓损伤中22例此类损伤作随访分析，对其诊断、治疗及可能发生的原因进行探讨。认为：（1）MRI能显示脊髓伤后的早期变化，对预后及治疗有重要的指导意义。（2）除了过伸损伤，其它损伤机制也能导致此类损害。（3）脊髓血管损伤、出血、髓内代谢产物沉积在这类损伤产生过程中占重要地位。（4）非手术治疗与单纯椎管减压术疗效比较无意义，而借助手术显微镜的髓内外联合减压术对该类损伤的恢复有一定帮助，即使完全性脊髓损伤亦不能轻易放弃积极治疗。     

Worklife After Traumatic Spinal Cord Injury

Abstract

Objective: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI).

Design: Inception cohort study.

Setting: Model SCI Care Systems throughout the United States.

Participants: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Centerdatabase since 1973.

Intervention: Not applicable.

Main Outcome Measure: Postinjury employment rates and worklife expectancy.

Results: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act.

Conclusions: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.     

Impact of Peripherally Inserted Central Catheters on Phlebitic Complications of Peripheral Intravenous Therapy in Spinal Cord Injury Patients

Abstract

We investigated the impact of peripherally inserted central catheter (PICC) placement in spinal cord injury patients at high risk for infusion phlebitis. The rate and etiology of phlebitis was investigated in two phases. During Phase I, peripheral IV cannulae and conventional central venous catheters (CVC) were used. During Phase II, patients identified to be at risk for phlebitis received PICCs. The number of peripheral IVs, CVCs and PICCs was tabulated for both phases of the study. Technical, infectious and thrombotic complications were studied prospectively for PICCs and retrospectively for CVCs. We found the rate of phlebitis was 16.5 percent and 2.4 percent for Phases I and II, respectively (p=0.0002). Three infections occurred in 38 PICCs and one infection was documented in 13 conventional CVCs. The number of peripheral IVs and conventional CVCs was reduced significantly from Phase I to Phase II. No procedural complications, catheter sepsis or clinically apparent venous thrombosis occurred. In conclusion, PICCs reduced the rate of phlebitis thresholds with a low complication rate and reduced the use of peripheral IVs and conventional CVCs. (J Spinal Cord Med 1997;20:341-344)     

急性颈脊髓中央损伤综合征的治疗

目的探讨急性颈脊髓中央损伤综合征的治疗效果。方法对我院1990年1月至2004年1月收治的32例急性颈脊髓中央损伤综合征患者进行回顾性分析,其中非手术治疗14例,手术治疗18例,在治疗前后进行JOA评分。结果平均随访21个月,非手术治疗组脊髓功能恢复差。而手术治疗病例脊髓功能恢复较好。结论急性颈脊髓中央损伤综合征手术治疗效果明显优于非手术治疗,急性颈脊髓中央损伤一旦确诊,应当积极早期手术治疗。     

Neurocytoma of the Thoracic Spinal Cord

Summary.  Central neurocytoma is an unusual tumour that arises in the supratentorial ventricular system of young adults. Similar lesions, termed simply neurocytoma, have been described at a variety of locations outside the ventricular system. Here, we report the case of a 50-year-old man who presented with pain and a rapidly progressive myelopathy due to a neurocytoma of the upper thoracic spinal cord. The literature on spinal neurocytoma and its relation to central neurocytoma are discussed. Published online August 12, 2002