摘要
目的探讨糖皮质激素(GC)治疗对硬脊膜动静脉瘘和脊髓髓内动静脉畸形(AVM)并发静脉高压性脊髓病(VHM)的危害与处理策略。方法回顾性分析21例硬脊膜动静脉瘘与1例脊髓髓内AVM合并VHM患者的临床资料。因误诊为急性脊髓炎等疾病,使用GC治疗后使患者原有的脊髓功能障碍迅速加重。经选择性脊髓血管造影明确诊断后,采取手术切除与血管内栓塞动静脉瘘口的综合治疗。观察患者术前GC对VHM患者脊髓功能的影响及手术治疗对脊髓功能恢复的效果。结果①应用GC治疗3 d后,评价脊髓功能的改良Aminoff-Logue评分均上升(病情恶化)。步态评分:22例均上升,用药前后差异有统计学意义,χM2=20.045,P<0.01;小便评分:除1例无变化,其余均上升,差异有统计学意义,χM2=19.048,P<0.01;大便评分:除5例无变化外,其余17例评分均上升,差异有统计学意义,χM2=15.059,P<0.01。②术后1个月,步态评分:8例恢复到用药前,14例上升;小便评分:11例恢复到用药前水平,10例上升,1例下降;大便评分:15例恢复到用药前状态,7例评分上升。③术后6个月步态评分与用药前比较,3例评分降低(进步),11例上升;小便评分12例恢复,7例较用药前改善,3例比用药前差;大便评分有6例评分下降,2例上升。④术后6个月综合状态评定:正常2例(9.1%),基本正常7例(31.8%),轻度异常9例(40.9%),中度异常3例(13.6%),重度异常1例(4.5%),其中正常和基本正常占40.9%。结论硬脊膜动静脉瘘合并VHM易误诊为急性脊髓炎。使用GC治疗后,可致患者脊髓功能障碍短期内进一步恶化。早期手术切除或栓塞动静脉瘘口缓解VHM是挽救脊髓功能的关键。
To investigate the adverse effects of glucocorticoids in the treatment of dural ar-teriovenous fistula and intramedullary spinal arteriovenous malformation （AVM） with spinal venous hyperten- sive myelopathy （VHM）. Methods The clinical data of 22 patients were analyzed retrospectively, 21 had dural arteriovenous fistula and 1 had intranledullary AVM with venous hypertensive myelopathy （VHM）. The original spinal cord dysfunction of the patients aggravated rapidly after treatment with corticosteroids because of misdiagnosed as acute myelitis and other diseases. After clear diagnosis with the selective spinal angiogra- phy, the comprehensive treatment of surgical resection and endovascular embolization of arteriovenous fistula were performed. The impact of preoperative glucocorticoids of the patients on spinal cord function in patients with venous hypertensive myelopathy and the effect of surgery or endovascular treatment on spinal cord func- tion recovery were analyzed. Results （~）After the 22 patients were treated with glucocorticoids for 3 days, they were all aggravated according to the elevation of modified Aminoff-Logue score （ evaluation of spinal cord function）. Gait score： The scores of all 22 patients increased. There was significant difference before and after medication （Xm2 = 20. 045, P 〈0.01 ）. Urine score： Except one had no change, the scores of the rest were all increased. There was significant difference （Xm2 = 19. 048,P 〈 0.01 ）. Stool score ： Except 5 had no change, the scores of other 17 patients were all increased. There was significant difference （X,,,2 = 15. 059, P 〈 0.01 ）. （~）One month after surgery, the gait scores of 8 patients returned to the status before medication. Urine scores of 11 patients returned to before medication, and 10 increased; stool scores of 8 patients returned to before medication, and 7 increased. （~Compared to before medication, the gait scores decreased in 3 patients at 6 months after surgery, and 11 increased. Urine scores returned to normal in 12 patients, 7 were improved compared to before medication, and 3 were worse than before medication; stool scores decreased in 6 patients, and 2 increased. @Comprehensive status assessment at 6 months after surgery： 2 patients （9. 1%） were normal, 7 （31. 8%） were nearly normal, 9 （40. 9%） were mildly abnormal, 3 （13.6%） were moderately abnormal, and 1 （4.5%） was severely abnormal. The normal and basically normal patients accounted for 40.9%. Conclusions Dural arteriovenous fistula with venous hypertension myelopathyis is likely to be misdiagnosed as acute myelitis. After using glucocorticoids, it may cause spinal cord dysfunction in the short-term. Early surgical resection or embolization of the arteriovenous fistula for relieving spinal venous hypertension is the key to salvage spinal cord function.
出处
《中国脑血管病杂志》
CAS
2013年第8期393-400,405,共9页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金资助项目(81171165)
关键词
脊髓血管疾病
糖皮质激素类
疾病恶化
显微外科手术
栓塞
治疗性
静脉高压性脊髓病
Spinal cord vascular diseases
Glucocorticoids
Diseases progression
Microsurgery
Embolization, therapeutic
Venous hypertensive myelopathy
作者简介
通讯作者：张鸿祺，Email：hqzh@vip．163．com
