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目的研究脊髓发育不良脊髓神经损害的临床病理生理学特点。方法本组共112例患儿,111例施行椎管内手术;单纯末段脊髓缺失1例,未手术。有脊膜修补史46例。依据112例患儿病史、体检以及MRI、尿流和肛肠动力学检查结果及肌电图(EMG)评价并行脊髓手术治疗。术中观察脊髓形态学改变并按照椎管内病变及其脊髓病理解剖改变将其分为终丝栓系(又分为A、B两亚型)、脊髓粘连、脊髓脂肪瘤、囊性占位、脊髓纵裂、静态病变等6型。依据综合评价结果将脊髓损害的病程分为5期,每期给予相应评分并做统计学分析。结果7组脊髓神经损害综合评分的方差分析和临床分期的秩和检验差异都有非常显著性意义(P<0.001或0.05)。直线相关与回归分析表明患儿年龄与脊髓神经损害间(r=0.55,P<0.001)和栓系组圆锥末端位置与首发症状年龄之间(r=0.44,P<0.001)都有显著正相关关系。结论脊髓神经损害是一个由椎管内病变及其脊髓形态学改变引起并进行性加重的动态病理过程。诊治方针应是早期诊断和施行椎管内手术治疗以改善预后,临床分期和病理学分型具有一定临床价值。
Objective To study the clinicopathological features of spinal cord dysplastic spinal cord injury. Methods A total of 112 children in this group, 111 cases underwent spinal surgery; simple segment of the spinal cord was missing in 1 case, no surgery. A history of spinal meningitis in 46 cases. Based on 112 children with a history of physical examination and MRI, urinary flow and anorectal kinesthetic findings and electromyography (EMG) evaluation of spinal cord surgery. Intraoperative observation of spinal cord morphological changes and in accordance with the spinal canal lesions and pathological anatomical changes will be divided into the terminal screw system (also divided into A, B two subtypes), spinal adhesions, spinal cord lipoma, cystic space , Spinal cord split, static lesions and other 6 types. Based on the results of the comprehensive evaluation of spinal cord injury course of the disease is divided into 5, each given corresponding score and do statistical analysis. Results There was a significant difference (P <0.001 or 0.05) between the variance analysis of the comprehensive score of spinal cord nerve injury and the rank sum test of clinical staging. Linear correlation and regression analysis showed that there was a significant positive correlation between the age of children and spinal nerve damage (r = 0.55, P <0.001) and the location of the conical tip of the tethered group and the age of first symptom (r = 0.44, P <0.001) relationship. Conclusions Spinal cord nerve injury is a dynamic pathological process caused by spinal canal lesions and morphological changes of spinal cord. Diagnosis and treatment guidelines should be early diagnosis and implementation of spinal surgery to improve the prognosis, clinical stage and pathological typing has some clinical value.