【摘要】 目的探讨硬脊膜动静脉瘘的个体化治疗方法。方法对41例磁共振影像和选择性脊髓血管造影确诊的硬脊膜动静脉瘘患者,根据临床诊断和病变节段的X线定位,分别采取血管内栓塞瘘口或半椎板开窗显微手术夹闭瘘口和引流静脉。术后进行个体化综合治疗,血管内栓塞瘘口者抗凝治疗;手术夹闭瘘口及引流静脉者针对影像学有无脊髓病变,早期开始综合治疗消除脊髓水肿,配合康复疗法恢复脊髓功能。结果 41例术后运动功能恢复和好转者占92.7%(38/41),无好转者占7.3%(3/41);感觉障碍恢复或好转者占95.1%(39/41)。随访3～24个月,全部病例症状无复发,无手术并发症。结论硬脊膜动静脉瘘的个体化治疗应当包括手术和手术后综合治疗两部分,个体化治疗有助于提高临床疗效。更多还原

【Abstract】 Objective To explore the approach, results and experience in individualized treatment of intra-spinal epidural arteriovenous fistula (SDAVF). Methods The diagnosis of 41 patients with SDAVF were verified by MRI and selective spinal angiography were retrospectively analyzed. Based on the diagnosis and roentgenodiagnostic localization of lesions of involved spinal segments, an entry of fistula and its drainage vein was occluded by means of intravascular embolization or through a simi-hemilaminectomy approach. Postoperative comprehensive treatment was individually carried out. Anti-coagulation management was used in patients underwent intravascular embolization, while a comprehensive treatment at early stage was given to diminish spinal cord edema based on MRI findings, accompanied with rehabilitation therapy so as to stimulate the functional recovery of spinal cord. Results The motor function recovered or improved in 92.7% patients(38/41), while 7.2% patients(3/41) remained unchanged. The sensory disturbance recovered or improved in 95.1% patients(39/41). During the follow-up period, neither recurrence nor complications were observed at 3 months and 24 months. A more favorable result was obtained in individualized treatment on SDAVF than that in the reported literatures. Conclusion An individualized treatment includes embolization or/and surgery accompanied with postoperative comprehensive management should be emphasized, and follow-up study has shown that individualized treatment is helpful and effective in improving the result of clinical management.更多还原