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[一种针对脊髓空洞症、脊柱侧弯、阿诺德-奇亚里畸形、脑干扭结、齿状突隐窝、特发性基底凹陷和扁平颅底的新型外科治疗方法]

[A new surgical treatment for syringomyelia, scoliosis, Arnold-Chiari malformation, kinking of the brainstem, odontoid recess, idiopathic basilar impression and platybasia].

作者信息

Royo-Salvador M B

机构信息

Servicio de Neurocirugía, Clínica Tres Torres, Barcelona, Jefe del, España.

出版信息

Rev Neurol. 1997 Apr;25(140):523-30.

PMID:9172910
Abstract

INTRODUCTION

Based on medullary traction as responsible for idiopathic syringomyelia (SMI), idiopathic scoliosis (ESCID), Arnold Chiari malformation (ARCH), platybasia (PTB), basilar impression (IMB), odontoid recess (RTO) kinking of the brain stem (KTC) and considering the medullary traction to be transmitted by the filum terminale (FT), a surgical technique for the section of FT (SFT) is described in three cases of SMI, one of ESCID, and one of ARCH with no lumbar dysraphia.

MATERIAL AND METHODS

A 34-year-old woman with cervico-brachialgias, paresthesias, bilateral babinski and a centro-medullary cavity C3-C7. A 26-year-old male with cervico-brachialgias, hypoestesia in left hemybody, and cervicobulbar cavity. A 19-year-old female with ESCID since the age of 14th, with episodes of reacuting, and 38o of dorsolumbar curvature. A 67-year-old woman with intense headache, hypoesthesia of the hands, paraparesia and ARCH. A 23-year-old man with marked tetraparesia, bilateral babinski, anesthesia of both legs, SMI, ESCID, ARCH and hydrocephaly.

RESULTS

After SFT: in the SMIs the thermo-algesic, disesthetic and algic dissociation disappeared. In ESCID there was a reduction to 31o in the curvature in nine months. On ARCH the headaches ceased and there was recovery of touch and paraparesia.

CONCLUSIONS

SFT is a useful etiological treatment for SMI, ESCID, ARCH. Also, in ESCID it is possible to avoid stress on the medulla due to its surgical reduction.

摘要

引言

基于髓质牵引被认为是特发性脊髓空洞症(SMI)、特发性脊柱侧凸(ESCID)、阿诺德·奇亚里畸形(ARCH)、扁平颅底(PTB)、基底凹陷(IMB)、齿状突隐窝(RTO)、脑干扭结(KTC)的病因,并考虑到髓质牵引是通过终丝(FT)传递的,本文描述了在3例SMI、1例ESCID和1例无腰椎神经管闭合不全的ARCH患者中进行终丝切断术(SFT)的手术技术。

材料与方法

一名34岁女性,有颈臂痛、感觉异常、双侧巴宾斯基征阳性,C3 - C7水平有中央髓腔。一名26岁男性,有颈臂痛,左侧半身感觉减退,有颈延髓空洞。一名19岁女性,自14岁起患有ESCID,有病情反复,胸腰段弯曲38°。一名67岁女性,有剧烈头痛、手部感觉减退、轻瘫和ARCH。一名23岁男性,有明显的四肢瘫、双侧巴宾斯基征阳性、双腿麻木、SMI、ESCID、ARCH和脑积水。

结果

SFT术后:在SMI患者中,温度觉 - 痛觉、感觉异常和痛觉分离消失。在ESCID患者中,九个月后弯曲度减小至31°。对于ARCH患者,头痛停止,触觉和轻瘫恢复。

结论

SFT是治疗SMI、ESCID、ARCH的一种有效的病因治疗方法。此外,对于ESCID患者,通过手术矫正可以避免对延髓的压迫。

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