Liu Jia-Ming, Shen Jian-Xiong, Zhang Jian-Guo, Zhao Hong, Zhao Yu, Li Shu-Gang, Zhao Li-Juan, Wang Yi-Peng, Qiu Gui-Xing
Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2012 Feb 21;92(7):468-71. doi: 10.3760/cma.j.issn.00376-2491-2012.07.010.
To explore the clinical manifestations and surgical strategies of scoliosis associated with syringomyelia.
A total of 50 cases diagnosed as scoliosis with syringomyelia between January 2003 and November 2010 were recruited. They were divided into 2 groups: Group A, neurosurgery before scoliosis correction, including suboccipital decompression and syrinx shunting; Group B, one-staged posterior correction and instrumentation without previous neurosurgery. The preoperative, postoperative and last follow-ups of Cobb angle of coronal main curve and thoracic kyphosis were measured. Also the preoperative and postoperative apical vertebra translation, apical vertebra rotation and trunk shift were measured by the same person. The surgical efficacies and complications of correction were compared between 2 groups.
All patients underwent posterior pedicle screw instrumentation and had a mean follow-up period of 32.1 months. Among them, 42 patients had clinical symptoms or signs preoperatively and 3 patients improved postoperatively. The mean correction of coronal curve was 65.7% and a mean loss of correction 6.4% during the follow-up. The mean correction of apical vertebra translation and apical vertebra rotation were 63.0% and 60.0% respectively. However, the trunk shift increased 0.4 cm. There were no statistically significant differences for the correction efficacies and complications between 2 groups (P > 0.05).
Scoliosis associated with syringomyelia may be effectively managed if a surgeon manipulates carefully intraoperatively and perioperative spinal monitoring is practiced. Furthermore syrinx will not increase the incidence of postoperative complications without prophylactic neurosurgery.
探讨合并脊髓空洞症的脊柱侧凸的临床表现及手术策略。
选取2003年1月至2010年11月期间诊断为合并脊髓空洞症的脊柱侧凸患者50例。将其分为2组：A组，脊柱侧凸矫正术前先行神经外科手术，包括枕下减压及脊髓空洞分流术；B组，未先行神经外科手术，一期行后路矫正及内固定术。测量冠状面主弯Cobb角及胸椎后凸术前、术后及末次随访时的角度。同时由同一人测量术前及术后顶椎平移、顶椎旋转及躯干偏移情况。比较2组矫正手术的疗效及并发症。
所有患者均接受了后路椎弓根螺钉内固定术，平均随访时间为32.1个月。其中，42例患者术前有临床症状或体征，3例术后症状改善。冠状面曲线平均矫正率为65.7%，随访期间平均矫正丢失率为6.4%。顶椎平移及顶椎旋转平均矫正率分别为63.0%和60.0%。然而，躯干偏移增加了0.4 cm。2组矫正疗效及并发症差异无统计学意义（P > 0.05）。
如果外科医生术中操作仔细并进行围手术期脊髓监测，合并脊髓空洞症的脊柱侧凸可得到有效治疗。此外，在未行预防性神经外科手术的情况下，脊髓空洞不会增加术后并发症的发生率。
