脊髓萎缩（附2例报告）

本文报告了两例脊髓萎缩，并结合文献复习讨论了该病的好发部位、病因、临床表现、诊断和治疗。脊髓萎缩的病因多为继发性，也可为特发性。根据临床表现结合脊髓ＣＴ造影及ＭＲＩ检查，可以明确诊断。     

“High spinal” dysrhaphism

Summary High spinal (cervical and upper thoracic) dysrhaphism usually involves either a meningocele or a dermal sinus tract. These high spinal lesions can have a complex intradural anatomy at the level of the lesion (as this case reports) and are associated with an increased incidence of lower spinal occult dysrhaphic anomalies. It is therefore recommended that patients with high spinal dysrhaphism undergo radiological evaluation of the entire spine to identify those patients with intradural anomalies, define the anatomy for surgery, and investigate the lower spine for associated occult anomalies.     

Morphological analysis of the cervical spinal canal,dural tube and spinal cord in normal individuals using CT myelography

To verify the conventional concept of developmental stenosis of the cervical spinal canal, we performed a morphological analysis of the relations of the cervical spinal canal, dural tube and spinal cord in normal individuals. The sagittal diameter, area and circularity of the three structures, and the dispersion of each parameter, were examined on axial sections of CT myelograms of 36 normal subjects. The spinal canal was narrowest at C4, followed by C5, while the spinal cord was largest at C4/5. The area and circularity of the cervical spinal cord were not significantly correlated with any parameter of the spinal canal nor with the sagittal diameter and area of the dural tube at any level examined, and the spinal cord showed less individual variation than the bony canal. Compression of the spinal cord might be expected whenever the sagittal diameter of the spinal canal is below the lower limit of normal, that is about 12 mm on plain radiographs. Thus, we concluded that the concept of developmental stenosis of the cervical spinal canal was reasonable and acceptable.     

Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study

We performed whole-spine heavily T2-weighted magnetic resonance (MR) myelography using a single-shot fast spin-echo pulse sequence in 17 patients (8 M/9 F) with spontaneous intracranial hypotension (SIH) to detect abnormal cerebrospinal fluid (CSF) collections. In addition, a group of age- and sex-matched controls were recruited. Follow-up MR myelography was also done at 3 weeks. MR myelography showed three kinds of abnormal CSF collections in 15 patients with SIH (88%): epidural fluid collection (n = 15, 88%), C1-2 extraspinal collections (n = 6, 35%) and CSF collections along nerve roots in the lower cervical or upper thoracic spines (n = 6, 35%). One patient (6%) showed a meningeal diverticulum. In contrast, none of the controls showed these findings. Overall, MR myelography results helped in early diagnosis of SIH in four (24%) patients whose initial brain MRIs failed to show typical SIH findings. Follow-up MR myelography results were compatible with the clinical changes with kappa statistics of 0.52 and an agreement rate of 76%. Our study showed heavily T2-weighted MR myelography provided a rapid, non-invasive and high yield method to diagnose and follow-up patients with SIH. Whether the CSF collections along the nerve roots represent the ongoing leakage sites warrants further study.     

经椎间孔增强神经根造影引导下硬脊膜激素类注射治疗腰椎间盘突出症

目的探讨经椎间孔增强神经根造影引导下硬脊膜激素类注射(ESIs)治疗腰椎间盘突出症的临床疗效。方法对59例腰椎间盘突出症患者行经椎间孔增强神经根造影引导下ESIs治疗。采用疼痛VAS评分和JOA评分评价疗效。结果患者均获得随访,时间12~16个月。VAS评分与JOA评分术后12个月与术前比较差异均有统计学意义(P<0.05)。治疗改善率85.1%±13.9%,优良率94.9%。患者均未发生重要血管、神经损伤、血肿压迫及感染等严重并发症。结论经椎间孔增强神经根造影引导下ESIs是治疗腰椎间盘突出症的有效方法。     

经椎弓根短节段固定治疗胸腰椎爆裂性骨折

目的 探讨后路短节段固定治疗胸腰椎爆裂性骨折的方法.方法 应用短节段钉棒系统经椎弓根复位、固定,Ⅰ期植骨融合,治疗胸腰椎爆裂性骨折32例.有神经损伤或压迫症状者,术中椎管造影,如确定后突骨块复位不满意者,行半椎板切除,椎管扩大减压,椎体间植骨.结果 术后29例基本解剖复位,3例大部分复位,并恢复了正常的脊柱力线.不全瘫者10例术后均有不同程度的功能恢复,完全瘫者3例,2例功能无恢复.26例经随访1～3年,矫正角度基本未丢失,未出现断钉、脱棒等现象,23例植骨融合,融合率达88.5%.结论 该手术方法复位满意,固定可靠,对椎管的间接减压是有效的,并最大限度地保留了未损伤的运动节段功能,但患者需另取髂骨,部分患者供区遗留顽固性疼痛.     

后入路手术治疗胸腰段爆裂性骨折

目的分析后入路手术治疗胸腰段爆裂性骨折的疗效及适应证。方法应用后入路手术治疗胸腰段爆裂性骨折38例。从影像学、手术操作过程及神经功能恢复等方面分析疗效。结果伤椎高度由47·3%恢复到94·4%;水平移位完全恢复;Cobb角由术前22·6°恢复到术后3·6°。椎管受压程度:删除椎管开放减压的7例,余受压面积由术前42%恢复到术后16%,受压的矢状径从术前54·9%恢复到81·8%。脊髓神经功能恢复依照Frankel分级标准均有1级以上改善。结论合理选择后入路手术对胸腰段爆裂性骨折治疗效果良好,手术中进行椎管造影有助于提高复位效果。     

Use of flat panel DynaCT myelography to locate the site of CSF leak

Spontaneous intracranial hypotension is often treated conservatively or with epidural blood patch. Patients who are resistant to these treatments require accurate imaging localisation of the site of cerebrospinal fluid (CSF) leak for surgical repair. We describe two patients where MRI, CT myelography and MRI gadolinium myelography showed evidence of a large volume of epidural CSF, but failed to identify the pressure site of leak. Subsequently, DynaCT (Siemens, Erlangen, Germany) accurately identified the site with confidence in both cases, confirmed at surgery. This technique of using a flat panel detector‐based, angiographic system to produce high quality, high‐contrast multiplanar CT images for detecting the source of rapid CSF leak is detailed.     

自动拼接全脊柱磁共振水成像在椎间盘疾病中的诊断价值

目的探讨基于自动拼接技术的高场强全脊柱磁共振脊髓水成像在诊断椎间盘突出和椎管狭窄方面的价值。方法使用荷兰Philips Achieva 3.0T超导磁共振机,对40例患者进行全脊柱MR检查及水成像检查,由两名高年资医生从椎间盘是否突出、突出位置及程度,硬膜囊和神经根显示及受压程度、椎管狭窄等方面比较常规MR和脊髓水成像,采用SPSS10.0软件包进行统计学分析。结果脊髓水成像在诊断椎间盘突出方面的敏感性、特异性、假阴性分别为90%、100%、10%。脊髓水成像发现神经根受压的敏感性、特异性、假阳性分别为100%、90%、0.7%。脊髓水成像诊断椎管狭窄的敏感性、特异性、假阴性分别为94.4%、100%、0.07%。结论基于自动拼接技术的全脊柱磁共振脊髓水成像是一种有效、快速、无创的全椎管造影成像技术,可作为常规MRI检查的补充,明显提高椎间盘病变的诊断率。     

Thoracic spinal intradural arachnoid cyst: report of two cases and review of literature

We report two cases of spinal intradural arachnoid cyst at the thoracic level, presenting with long-standing symptoms of spinal cord compression and MRI findings that were overlooked for sometime initially. Because of the rarity of this disease, and because of the subtle changes on MRI, there was a definite delay in the diagnosis. In this report we emphasize the value of MRI and CT myelography in this disorder, and the need for them to be strongly correlated with the progression of the clinical picture.