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双语推荐：脊髓圆锥

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目的通过观察胎儿脊髓圆锥末端位置,确定其与脊柱区病变的相关性。方法回顾性分析本院产前超声诊断胎儿显性脊柱裂10例,隐性脊柱裂3例,骶尾部畸胎瘤3例,腰骶管内囊肿1例及1013例正常胎儿的超声资料,均定位脊髓圆锥末端位置,并与产后超声对照。结果显性脊柱裂及腰骶管内囊肿均表现脊髓圆锥低位,隐性脊柱裂脊髓圆锥可以正常也可以低位,骶尾部畸胎瘤及正常对照组脊髓圆锥位置均正常。结论超声定位脊髓圆锥末端位置对诊断脊柱区病变能提供有价值的信息,具有重要临床价值。
Objective To determine correlation of conus medullaris in fetuses and spinal lesions through observation.Methods Retrospectively analyzing ultrasonic data of prenatal ultrasound diagnosis of fetal spina bifida(10 cases), occult cleft spine(3 cases), sacrococcygeal teratoma(3 cases), lumbar and sacral canal cyst(1 case) and 1013 cases of normal fetal, all locating conus medullaris, summarizing the sonographic features and comparing with postpartum ultrasonic.Results Spina bifida and lumbar and sacral canal cyst showed low conus medullaris position, occult cleft spine showed normal or low conus medullaris position, in cases of sacrococcygeal teratoma and the normal control group, the level of conus medullaris were normal. Conclusion Ultrasonic locating conus medullaris can provide valuable information for the diagnosis of spinal lesions, so it has important clinical value.

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目的：通过 MRI 检查成人脊髓圆锥末端位置的变化,为腰麻穿刺提供信息。方法120例病人术前行腰部 MRI扫描：正中矢状面测量脊髓圆锥末端的位置,并按脊柱单元分区。结果120例脊髓圆锥末端位置与年龄、性别、身高、体重和体重指数无明显相关；范围在 T12-L2-3水平,主要集中在 T12-L1（15%）、 L1 U （21.7%）、 L1 M （23.3%）和 L1 L （18.3%）之间,8例位于 L1-2水平以下,其中1例女性在 L2-3水平。结论 MRI 检查能够准确判断成人脊髓圆锥末端位置,为腰麻提供信息,避免穿刺时损伤脊髓。
Objective To examine the changes of the position of adult spinal cord conus end by MRI, and provide information for spinal anesthesia puncture. Method 120 patients were given lumbar MRI scan before operation. The position of adult spinal cord co-nus end was measured at median sagittal plane and divided into partition according to spine unit. Result The position of spinal cord conus end of the 120 patients was not associated with age, sex, height, weight and body mass index, in the range of T12-L2-3 , mainly in T12-L1 (15% ), L1 U (21. 7% ), between L1 M (23. 3 % ) and L1 L (18. 3% ), with 8 cases below L1-2 , in which one case of women was within L2-3 level. Conclusion MRI examination can accurately determine the adult spinal cord conus end position, pro-vide information for spinal anesthesia, and avoid puncture damage to spinal cord.

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目的：了解终丝脂肪瘤型脊髓栓系综合征（TCS）患儿的临床表现和诊治特点。方法回顾性分析61例（7个月~14岁）终丝脂肪瘤型 TCS 患儿的临床资料，术前均行放射影像学、尿流动力学、肌电图检查，手术方式采用脂肪瘤切除，终丝离断加椎板成形术治疗。术后复查 MRI 及尿流动力学，比较患儿手术前后脊髓受牵拉情况及尿流动力学等各指标的变化。结果术前 MRI 显示终丝处有不同程度的脂肪信号，其中52例 TCS 患儿脊髓圆锥末端位置在第2腰椎椎体下缘以下，9例脊髓圆锥末端位置正常；术后显示圆锥位置无明显变化，脂肪瘤移除、终丝紧张解除。尿流动力学结果显示术前37例患儿存在逼尿肌过度活动，19例逼尿肌收缩乏力，5例逼尿肌部分收缩功能受损伴膀胱残余尿量增多；术后49例患儿取得较好疗效，余12例下肢情况得到改善，但尿流动力学表现改善不明显。结论终丝脂肪瘤型脊髓栓系综合征起病隐匿，诊断需综合考虑其临床表现、放射影像学、肌电图及尿流动力学检查结果，而 MRI 及尿流动力学检查是诊断的关键指标。
Objective To investigate the clinical characteristics,diagnosis and management of tethered cord syndrome(TCS)with filum terminale lipomain children. Methods The clinical data of 61 children(7 months - 14 years old)with filum terminale lipoma were analyzed retrospectively. The auxil-iary examinations including radiography examination,electromyogram examination and urodynamictest. Every child was surgically treated by transecting the filumterminalelipoma and laminoplasty MRI and uro-dynamic index were reviewed after operation,and the spinal cord tethering condition by MRI scaning and the parameters of urodynamic study before operation and after operation were compared. Results Before operation,MRI showed fat signal in the filum,and the conusmedullaris was found at the low level(below the body of L2)on MRI in 52 cases of TCS,conusmedullaris was found at the normal level(above the body of L2)in 9 cases. The position of conusmedullaris showed no significant change,but the filumtemi-nale ten

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目的：探讨脊髓栓系综合征（tethered cord syndrome,TCS）的MRI征象,结合分型判断其诊断意义。方法：对19例脊髓栓系综合征MRI征象回顾性分析。结果：19例TCS中MRI扫描示脊髓圆锥低位19例,脊髓终丝增粗17例,终丝、马尾粘连11例,腰骶椎、腰骶管发育异常7例,表现为腰骶部椎管变窄或增宽;椎管内脂肪瘤（脂肪堆积）8例;腰骶部皮毛窦2例。结论：MRI具有良好的组织分辨率,是脊髓栓系综合征首选检查方法,可为其诊断与手术提供准确的影像学资料。
Objective:To explore the MRI signs of tethered cord syndrome(TCS),combined with the classification,to determine its diagnostic significance.Method:19 cases of MRI manifestations of tethered cord syndrome were retrospectively analyzed.Result:19 cases of TCS conus medullaris low was 19 cases,MRI scans indicated in the spinal cord filum terminale enlargement in 17 cases,filum terminale,horsetail adhesion in 11 cases,lumbosacral vertebra,lumbar sacral canal dysplasia in 7 cases,expression was lumbar spinal canal narrowing or widening.Spinal canal lipoma(fat) 8 cases,lumbar fur sinus in 2 cases.Conclusion:MRI has good tissue resolution,is the preferred tethered cord syndrome check method,can provide accurate imaging for the diagnosis and operation data.

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目的探讨脊髓纵裂的MSCT和MRI影像学特征及诊断价值。方法回顾性分析13例经临床证实的脊髓纵裂的MSCT及MRI影像学表现。结果本组Ⅰ型12例,均为骨性间隔,其中完整性骨性间隔10例,不完整性骨性间隔2例;Ⅱ型1例,为纤维性间隔;同时可分别伴有脊柱畸形、背侧皮窦、脊髓栓系及椎管内皮样囊肿等畸形。MSCT横轴位及MPR可清楚显示骨性间隔的部位、形态、走向、范围及椎体、椎板畸形等情况。MRI可以明确纵裂间隔的位置、形态、分裂脊髓是否位于同一硬膜囊内、脊髓圆锥位置、终丝情况及伴发病变。结论 MSCT及MRI联合应用可以对脊髓纵裂及伴发的其他畸形做出明确诊断。
Objective To study the features and diagnostic value of MSCT and MRI in diastematomyelia. Methods MSCT and MRI imagings of 13 patients with diastematomyelia proved clinically were analyzed retrospectively. Results Of the 13 cases,12 cases were type I ,both osseous septum,included complete form of osseous septum (10cases),incomplete esseous septumm (2cases);1 case was type II,with fibrous septum.All the cases were accompanied by spinal deformity,dorsal cutaneous sinus,tethered cord and endothelial cyst. MSCT axial and MPR can clearly show the location,shape, alignments, range of the osseous septum and vertebral deformities. MRI can clearly diagnose whether split spinal is in one single dural sac, the location and shape of the interhemispheric interval, conus position, the end of wire and concomitant lesions. Conclusion MSCT combined with MRI can make an accurate diagnosis in diastematomyelia(DM).

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目的：回顾性分析27例儿童脊髓栓系综合征患者的手术疗效，评价神经电生理监测在显微手术治疗脊髓栓系综合征中的作用和意义。方法全部27例术前均经MRI诊断为脊髓栓系综合征，其中8例为低位脊髓圆锥、终丝短粗或伴有脊髓外翻，无明显神经功能障碍；19例伴有脊髓脂肪瘤/血管脂肪瘤者有神经功能障碍，主要表现为小便功能障碍和下肢运动功能障碍。全部患者均在术中神经电生理监测下行脊髓松解术，术中持续监测肌电图，并以神经刺激器主动刺激鉴别终丝和神经根。术后随访20～62个月，平均35.3个月，对患者术前及术后不同临床症状进行配对t检验和Cochran-Mantel-Haenszel检验分析。结果全部病例术后临床症状均无加重，19例伴有脂肪瘤的患者中，14例（73.7%）改善，5例（26.3%）无明显改善，11例（57.9%）脂肪瘤全切除，8例（42.1%）大部分切除。结论显微手术中，神经电生理监测技术有助于对正常神经组织与栓系因素界面的辨别，可使神经外科医生对脊髓栓系与正常的终丝和神经根等进行最大程度的松解，并获得更好的疗效。
Objective Retrospectively analysing the efficacy and the utility of the surgery on tethered spinal cord syndrome (TSCs) of children, to explore the value of intraoperative electrophysiological monitoring (EPG) guiding microsurgery on TSCs of children.MethodsFrom January 2008 to July 2011, 27 children mean aged 3.5 years (range 3 d-12 y) with TSCs underwent microsurgery guided by intraoperative EPG. All patients were diagnosed by MRI before operation. 8 patients appeared lower conus medullaris, filum terminale short, or spinal cord eversion, and no obvious neurological deficits. 19 patients appeared TSCs with spinal lipoma/angiolipoma, and obvious neurological deficits, including sphincter disturbances and lower limb motor dysfunction.In all cases, both passive (electromyography) and active (detection of compound muscle action potentials) electrophysiological monitoring was used. Clinical symptom were reviewed to evaluate the utility of electrophysiological guidance and patient outcomes

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目的分析脊髓终丝血管畸形的临床特点和治疗转归。方法回顾性分析2008年1月—2013年12月诊治的6例终丝血管畸形(由脊髓前/后动脉供血,病变位于脊髓圆锥以下的动静脉瘘或动静脉畸形,并且不合并其他部位的脊髓血管畸形)患者的临床资料。对6例患者实施显微外科手术和(或)血管内栓塞治疗,手术前和手术后1年行脊髓功能AminoffLogue量表评分和MRI检查。结果患者均为男性,表现为双下肢无力和二便障碍(4例),病程平均(17±5)个月。6例病理类型均为动静脉瘘,供血动脉包括腰动脉、髂内动脉和骶正中动脉。对6例患者行Onyx胶栓塞治疗2例,手术治疗3例,栓塞联合手术治疗1例,均达到解剖治愈。1年后AminoffLogue评分改善[术前(3.8±1.9)分,术后(2.8±2.0)分],但差异无统计学意义(P0.05)。其中肌力评分3例改善,2例不变,1例加重;二便功能2例改善,2例不变。结论终丝血管畸形是一种罕见的脊髓血管畸形,栓塞和手术治疗可达到解剖治愈的效果,虽只能部分恢复或不能恢复脊髓功能,但可阻断脊髓功能的继续恶化。
Objective Toanalyzetheclinicalcharacteristicsandtreatmentoutcomesofspinalfilum terminalevascularmalformation.Methods Theclinicaldataof6patientswithfilumterminalevascular malformation diagnosed and treated from January 2008 to December. 2013 were analyzed retrospectively. The definition of filum terminale vascular malformation is anterior/posterior spinal artery feeding arteriovenous fistula or arteriovenous malformation and located below conus medullaris,and does not complicate with spinal vascular lesions in the other part. The Aminoff & Logue score and MRI of spinal cord function were performedatoneyearaftermicroneurosurgeryand/orendovascularembolization.Results Allpatients were males. Their clinical presentations were the weakness of both lower extremities and sphincter disturbance. The mean course of disease was 17. 1 ± 5. 2 months. The pathological type of the 6 patients were all arteriovenous fistulas. The feeding arteries included lumbar artery,internal iliac artery,a

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目的探讨非创伤性脊髓损伤患者的人口学特征、病因学分布以及神经功能预后。方法对44例非创伤性因素造成的脊髓损伤患者的临床资料进行回顾性分析。结果患者均获得3个月以上随访,平均随访时间13.3个月(3~23个月)。其中男性27例(61.3%),女性17例(38.7%);平均年龄39.85岁(3.5~78岁)。病因包括脊髓炎16例(36%),脊柱肿瘤8例(18.1%),椎管内肿瘤7例(15.9%),脊髓血管畸形6例(13.6%),非创伤性椎间盘突出3例(6.8%,包括颈椎间盘突出致四肢瘫1例,腰椎间盘突出致马尾综合征2例),非脊柱手术造成的医源性脊髓缺血2例(4.5%),肝性脊髓病2例(4.5%)。入院时神经损伤情况:颈段脊髓损伤9例(20.4%),胸段损伤30例(68.1%),圆锥综合征2例(4.5%),马尾综合征3例(6.8%)。AISA残损分级:A级14例(31.8%),B级6例(13.6%),C级13例(29.5%),D级11例(25%)。最终随访时,34%患者出现至少1个等级的神经功能恢复。结论非创伤性脊髓损伤是造成脊髓损伤的重要原因。因具有特殊的病因学特点,此组病例在人口学特征以及临床特点上与创伤性脊髓损伤患者有较大区别。
Objective To investigate the clinical characteristics of nontraumatic spinal cord injury, including the demographic character-istics, etiology and neurological function. Methods 44 patients with nontraumatic spinal cord injury in the past 4 years were reviewed. Re-sults There were 27 males (61.3%) and 17 females (38.7%) with mean age of 39.85 years (3.5~78). They were followed up for mean of 13.3 (3~23) months. Myelitis (36%) and spinal tumor (including primary and metastatic tumor, 18.1%) were the most common causes, followed by intraspinal tumor (15.9%), vascular disease (13.6%), nontraumatic acute disc herination (6.8%), spinal cord ischemia after non-spinal sur-gery (4.5%) and hepatic myelopathy (4.5%). Neurological function at the initial admission included tetraplegia in 9 patients, paraplegia in 30 patients, conus medullaris syndrome in 2 patients and cauda equina syndrome in 2 patients. Neurological function of ASIA at the initial admission included A in 14 cases, B in 6, C in

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