Hirabayashi S, Kumano K, Ohnishi I, Hoshino Y, Nakamura K, Kurokawa T
Department of Orthopaedic Surgery, Kantoh Rosai Hospital, Kawasaki, Japan.
J Spinal Disord. 1995 Apr;8(2):93-102.
In neurologic examination of patients with a suspected compressive lesion at the thoracic region, the dermatomic level of sensory disturbance is the only index indicating the anatomic level of a lesion. Because spinal cord tumors usually are solitary compressive lesions, the relationship between the anatomic and dermatomic levels is conveniently examined. We examined the relationship between the highest dermatomic level of sensory disturbance and the anatomic level, axial location, and type of spinal cord tumors in the thoracic region in 19 patients (8 men and 11 women aged 27-78 years; 11 neurinomas, 7 meningiomas, 1 neurofibroma). The distribution of sensory disturbance was evaluated with 3-g Frey hair and 1-g pin-prick examinations. The dermatomic distribution of sensory disturbance was diagnosed according to the dermatome chart of Keegan and Garrett. The anatomic level and axial location of the tumor were highly related to the sensory disturbance. Eight of 12 tumors in which the dermatomic level of sensory disturbance was within one vertebral segment of the anatomic level were situated in the middle or lower thoracic region (T6-T10). All five tumors in which the dermatomic level was two or more vertebral segments away from the anatomic level were situated at the conus medullaris (T12) or upper thoracic region (T1-T5); the highest level of sensory disturbance was from 4 to 11 segments below the anatomic level of the tumor. In two patients with no sensory disturbance, the tumor was in the upper thoracic region (T5) and compressed the spinal cord from the dorsal side. When a spinal cord tumor at the thoracic region is suspected, imaging examinations should be performed sufficiently cranially.
在对疑似胸段有压迫性病变的患者进行神经学检查时，感觉障碍的皮节水平是指示病变解剖水平的唯一指标。由于脊髓肿瘤通常是孤立的压迫性病变，因此可以方便地检查解剖水平与皮节水平之间的关系。我们检查了19例患者（8例男性和11例女性，年龄27 - 78岁；11例神经鞘瘤、7例脑膜瘤、1例神经纤维瘤）胸段脊髓肿瘤的最高感觉障碍皮节水平与解剖水平、轴向位置及肿瘤类型之间的关系。使用3克的Frey毛发和1克的针刺检查评估感觉障碍的分布。根据Keegan和Garrett的皮节图诊断感觉障碍的皮节分布。肿瘤的解剖水平和轴向位置与感觉障碍高度相关。感觉障碍皮节水平在解剖水平的一个椎体节段范围内的12例肿瘤中，有8例位于胸段中部或下部（T6 - T10）。皮节水平与解剖水平相差两个或更多椎体节段的所有5例肿瘤均位于脊髓圆锥（T12）或胸段上部（T1 - T5）；感觉障碍的最高水平在肿瘤解剖水平以下4至11个节段。在2例无感觉障碍的患者中，肿瘤位于胸段上部（T5），从背侧压迫脊髓。当怀疑胸段有脊髓肿瘤时，应在足够靠上的部位进行影像学检查。
