Salari Farhad, Golpayegani Mehdi, Habibi Zohreh, Yaghoubi Shahin, Anbarlouei Mousarreza, Mehdizadeh Mehrzad, Nejat Farideh
Department of Neurosurgery, Tehran University of Medical Science, Tehran, Iran.
Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Pediatr Neurosurg. 2019;54(5):324-328. doi: 10.1159/000502403. Epub 2019 Sep 5.
Myelomeningocele (MMC) is the most common neural tube defect. Patients with MMC have multiple risk factors for venous thrombosis, but this complication rarely occurs. This lower rate of venous thrombosis in MMC children could be related to some characteristics of the vessels in the lower extremities. This study aimed at finding explanations for this dilemma.
A case-control study was designed in the Children's Hospital Medical Center, Tehran considering paraplegic patients with MMC as the case group and nonparaplegic MMC patients as a control group. Doppler ultrasound was performed to evaluate femoral and popliteal arterial and venous properties.
Patients aged from 8 months to 12 years were evaluated. The mean diameter of the femoral arteries was 3.73 ± 0.23 and 4.72 ± 0.39 mm among paraplegic and nonparaplegic MMC patients, respectively (p = 0.02). The femoral artery flow was 0.52 ± 0.08 and 0.75 ± 0.06 L/min, respectively in the case and control groups (p = 0.015). The diameters of the femoral veins were 4.85 ± 0.34 and 5.13 ± 0.32 mm in the case and control groups, respectively (p > 0.05). Besides, the blood flows of the case and control groups' femoral veins were 0.27 ± 0.08 and 0.14 ± 0.01 L/min, respectively (p = 0.6). It turned out that lower extremities' arteries in the case group had significantly lower blood flow and diameter compared to those of the control group. However, the same venous properties did not show any significant differences.
The decreased arterial flow along with the unchanged venous properties leads to less stasis and better drainage of the blood, which in turn might result in a lower incidence of deep vein thrombosis.
脊髓脊膜膨出（MMC）是最常见的神经管缺陷。MMC患者有多种静脉血栓形成的危险因素，但这种并发症很少发生。MMC患儿静脉血栓形成率较低可能与下肢血管的某些特征有关。本研究旨在为这一困境找到解释。
在德黑兰儿童医院医学中心设计了一项病例对照研究，将截瘫的MMC患者作为病例组，非截瘫的MMC患者作为对照组。采用多普勒超声评估股动脉和腘动脉及静脉的特性。
对8个月至12岁的患者进行了评估。截瘫和非截瘫MMC患者的股动脉平均直径分别为3.73±0.23和4.72±0.39毫米（p = 0.02）。病例组和对照组的股动脉血流量分别为0.52±0.08和0.75±0.06升/分钟（p = 0.015）。病例组和对照组的股静脉直径分别为4.85±0.34和5.13±0.32毫米（p>0.05）。此外，病例组和对照组股静脉的血流量分别为0.27±0.08和0.14±0.01升/分钟（p = 0.6）。结果表明，与对照组相比，病例组下肢动脉的血流量和直径明显较低。然而，相同的静脉特性没有显示出任何显著差异。
动脉血流减少以及静脉特性不变导致血液淤滞减少和引流改善，这反过来可能导致深静脉血栓形成的发生率降低。
