脊髓纵裂分型治疗的疗效分析

目的探讨脊髓纵裂分型治疗的疗效。方法对1978年5月至2006年11月收洽的有完整资料的121例单管型及双管型脊髓纵裂患者的病历资料进行回顾性分析，并通过临床神经功能评分及胫后神经皮层体感诱发电位（FTNCSEP）P40波峰监测，评价其手术及非手术治疗的疗效。结果所有患者均得到随访，随访时间6个月～15年，平均2年6个月。96例双管型患者中手术治疗86例，术后观察和随访发现24例痊愈、22例有明显改善、28例有一定改善、12例无明确效果，临床神经功能评分及PTNCSEP术后有明显改变，尤其是以疼痛为主诉的患者恢复最为明显，手术总有效率为86％；10例双管型患者未行手术治疗，随访发现临床症状无明显改善且有加重趋势。单管型患者25例，手术治疗16例，术前、术后临床神经功能评分及胛NCSEP无明显变化；未手术治疗的9例，随访时上述指标亦无明显变化。结论双管型脊髓纵裂患者脊髓损害重且呈进行性加重，精细的手术治疗可以使大多数患者症状得到缓解，终止神经进行性损伤，确诊后应尽早手术。单管型脊髓纵裂患者脊髓损害轻，无须手术探查。

Effective analysis of diastematomyelia treated according to typing

Objective To evaluate the clinical treatments and results of the diastematomyelia (DM) treated according to its classification. Methods One hundred and twenty-one patients with diastematomyelia and admitted from May 1978 to November 2006 were reviewed with complete clinical materials in our hospital. According to the classification, there were single-tube in 25 cases and double-tube in 96 cases. One hundred and two patients of diastematomyelia were treated with operation and nineteen with conservative treatment. The clinical treatments and results were analyzed retrospectively according to scoring neural function and monitoring the peak P40 of posterior trivial nerve cortical somatosensory evoked potential(PTNCSEP) between prior treatment and post-treatment. Results The average followed-up was two years and six months (6 months to 15 years). Eighty-six patients of double-tube DM were operated. 24 cases were healed, 22 recovered obviously, 28 got improved in a way, and 12 had no clear results. The scores of neural function and PTNCSEP got improved significantly. The total operative success rate of double-tube diastematomyelia amounted to 86%. Especially the cases with pain recovered obviously. 10 cases of double-tube diastematomyelia had no obvious change after conservative treatment. 16 patients of single-tube DM with operation did not have significant change compared with before operation as well and 9 patients of single-tube with conservation treatment also had on change, through evaluation of neural function and PTNCSEP. Conclusion The spinal cord is damaged severely in double-tube diastematomyelia and aggravate gradually. Subtle operation could achieve symptomatic relief in many cases and terminate spinal cord lesion. So operation should be performed as soon as final diagnosis was made. The spinal cord is damaged slightly in single-tube diastematomyelia and the surgery is not indicated.