专题组织人:沈建雄教授
众所周知,先天性脊柱侧凸患者往往伴有较高比例的椎管内畸形,目前关于先天性脊柱侧凸合并椎管内畸形发生率的报道相差较大,比较常见的椎管内畸形包括脊髓纵裂、脊髓空洞、脊膜膨出、脂肪瘤、皮样囊肿、畸胎瘤等【1-4】。单纯脊柱侧凸外科矫形术即属神经高危因素。如合并椎管内畸形则脊柱侧凸的外科矫治将更为困难和危险。传统的观念有椎管内畸形的患者,先行椎管内畸形的神经外科手术,随后二期行先天性脊柱畸形的矫形手术【5-6】。目前有学者建议伴无症状椎管内畸形的先天性脊柱侧凸患者术前不对椎管内畸形进行预防性外科处理,手术矫形手术操作得当,术中注意加强脊髓监护,可以获得满意效果,并不一定增加其术后并发症的发生率【7-10】。是否有必要在侧凸矫正之前先处理椎管内畸形?合并椎管内畸形的患者采用何种治疗方案?目前尚存在争议。您认为:我们应该怎么做呢?
1、Prahinski JR.Polly DW,McHale KA.eta1.Occult intraspinal anomalies in congenital scoliosis[J]JPediatr Orthop,2000,20(1):59—63.
2、兰斌尚,王坤正,言传柱等.脊柱纵裂分型及临床意义[J].中华骨科杂志,2000,20(2):69-71.
3、Bradford DS,Heithoff KB.Cohen M.Intraspinalabnormalities and congenital spine deformities:aradiographic and MRI study[J].J Pediatr Orthop.1991,11(1):36_41.
4、Basu PS,Elsebaie H,Noordeen MH.Congenital spinal deformity:a comprehensive assessmentat presentation[J].Spine,2002,27(20):2255—2259.
5、ErsahlnY,Muduer S.Kocaman S,et al.Split spinal cord malformations in children[J] J Neurosurg,1998.88(1):57—65
6、Huppert SS,Le A,Schroeter EH,eta1.Embryonic lethality in mice homozygous for aprocessing—deficient allele of Notch 1.Nature,2000,405(6789):966—970.
7、Hui H,Tao HR,Jiang XF,eta1.Safety and efficacy of 1-stage surgical treatment ofcongenital spinal deformity associated with split spinal cord malformation.Spine(Phila Pa 1976),2012,37(25):2104-21 13.
8、Nishizawa S,Yokoyama T,Yokota N,eta1.Incidentally identified syringomyelia associated with Chiari I malformations:is earlyinterventional surgery necessary? Neurosurgery,2001,49:637-641.
9、王亭,邱贵兴,沈建雄.先天性脊柱侧凸合并脊髓分裂症的诊治探讨.中华外科杂志,2005,25(12):770.773.
10、程斌,李勇,王坤正,等.23例单管型脊髓纵裂的回顾性分析[J]中华骨科杂志,2003,23(5):275—278