Mau H, Nebinger G
Orthopädische Universitätsklinik und Poliklinik Tübingen.
Z Orthop Ihre Grenzgeb. 1987 Sep-Oct;125(5):567-75. doi: 10.1055/s-2008-1044756.
Three long-time and two ore three respectively shorter observations of scoliotics with syringomyelia are presented and the pertinent literature is discussed including the complex etiopathogenesis. An attempt is made to describe the concomitant scoliosis. The older the patients with syringomyelia so more frequently scolioses appear, up to about two thirds of all cases, resembling a deformity due to paralysis: Dorsal kyphoscoliosis with lumbar countercurve and lordosis, tendency towards a list of the trunk, eventually rapid progression not only in the growing age but also in adulthood. The scoliosis may preceed the neurologic symptoms for years as well as follow later. Spontaneous fusion of the curves may occur by broad based flat bony appositions to the vertebrae with round prominences as well, aetiologically probably due to syringomyelia: "dystrophic". Since the spinal cord of these cases is more ore less pre-damaged and does react very sensible to progression of the scoliosis, in this phase mainly laminectomy for decompression is indicated whereas treatment otherwise is administered with the help of a Milwaukee brace. If one decides exceptionally to perform a fusion operation the application of any essentional distraction force and contusion is to be avoided.
本文报告了3例长期观察以及2 - 3例相对短期观察的脊髓空洞症合并脊柱侧凸患者,并讨论了相关文献,包括复杂的病因发病机制。本文试图描述伴发的脊柱侧凸情况。脊髓空洞症患者年龄越大,脊柱侧凸出现的频率越高,在所有病例中可达约三分之二,类似于瘫痪所致的畸形:背侧脊柱后凸侧弯伴腰椎反向弯曲和前凸,躯干有倾斜倾向,不仅在生长发育期,而且在成年期都可能最终迅速进展。脊柱侧凸可能在神经症状出现前数年就已存在,也可能在之后出现。侧弯可能会通过广泛的扁平骨赘与椎体的圆形突出部自发融合,病因上可能与脊髓空洞症有关:“营养不良性”。由于这些病例的脊髓或多或少已预先受损,对脊柱侧凸的进展反应非常敏感,在此阶段主要应进行椎板切除术减压,而其他治疗则借助密尔沃基支具进行。如果异常决定进行融合手术,应避免施加任何必要的牵张力和挫伤。