胸腰椎外伤性脊髓空洞症的特征及其意义

目的 回顾分析胸腰椎外伤性脊髓空洞症的症体、体征及影像学改变，分析其发病机制及临床意义。方法 本组14例，男13例，女1例；年龄28－56岁。脊柱骨折部位为T111例，T127例，L6例。11例为爆裂型暴折，3例为骨折脱位。其中5例行前路减压、植骨融合、内固定术；1例行后路减压、植骨融合、内固定术；其余8例对症处理，未行手术治疗。结果 本组14例于伤后6个月－4年行胸腰椎MRI检查时被确诊为脊髓空洞症，空洞开头呈洞形6例，椭圆形5例，不规则3例。患者常出现以下症状；疾痛（78．6％，11／14）、下肢肌力减退（64．3％，9／14）、下肢痉挛性增加（42．9％，6／14）、感觉丢失或减退（42．9％，11／14）、下肢运动协调能力降低（14．3％，2／14）、自主神经症状（7．1％，1／14）等。结论 脊髓损伤神经功能稳定后一段时间，出现下肢肌力减退等新的神经症状应高度怀疑脊髓空洞症的发生。

Clinical manifestation and significance of post-traumatic thoracolumbar syringomyelia

Objective To analyze the clinical manifestation, the pathogenic mechanism and the clinical significance of post traumatic thoracolumbar syringomyelia. Methods A total of 14 patients (13 males and 1 female, their ages ranging from 28 to 56 years) with post traumatic thoracolumbar syringomyelia were studied retrospectively. One patient suffered from T 11 fracture, 7 from T 12 fracture and 6 from L 1 fracture. There were 11 patients with burst fractures and 3 with fracture dislocations. Anterior decompression, bone graft and fusion and internal fixation were made on 5 patients, posterior decompression, bone graft and fusion and internal fixation on 1 patient, and expectant treatment with no operation on 8 patients. Results The diagnosis of syringomyelia of the patients was set up by MRI from 6 months to 4 years after the initial thoracolumbar fracture. The syringomyelia was round in shape in 6 cases, ellipic in 5 cases and irregular in 3 cases. The patients with post traumatic thoracolumbar syringomyelia often suffered from pain(78.6%), myodynamia attenuation in lower extremities (64.3%), spasmus increase(42.9%), sensation loss or attenuation(42.9%), coordinate function decrease in lower extremities (14.3%) and autonomic nerve symptom (7.1%). Conclusions Post traumatic thoracolumbar syringomyelia should be thought about if the patients have new neurological symptoms such as myodynamia attenuation in lower extremities after the nerve function keeps steady from spinal cord injury.