CAJ | 학술논문

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Aminoff＆Logue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Aminoff＆Logue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（P＞0.05）。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。
목적：분석척수종사혈관기형적림상특점화치료전귀。방법회고성분석2008년1월-2013년12월진치적6례종사혈관기형（유척수전/후동맥공혈，병변위우척수원추이하적동정맥루혹동정맥기형，병차불합병기타부위적척수혈관기형）환자적림상자료。대6례환자실시현미외과수술화（혹）혈관내전새치료，수술전화수술후1년행척수공능Aminoff＆Logue량표평분화MRI검사。결과환자균위남성，표현위쌍하지무력화이편장애（4례），병정평균（17±5）개월。6례병리류형균위동정맥루，공혈동맥포괄요동맥、가내동맥화저정중동맥。대6례환자행Onyx효전새치료2례，수술치료3례，전새연합수술치료1례，균체도해부치유。1년후Aminoff＆Logue평분개선[술전（3.8±1.9）분，술후（2.8±2.0）분]，단차이무통계학의의（P＞0.05）。기중기력평분3례개선，2례불변，1례가중；이편공능2례개선，2례불변。결론종사혈관기형시일충한견적척수혈관기형，전새화수술치료가체도해부치유적효과，수지능부분회복혹불능회복척수공능，단가조단척수공능적계속악화。
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,and median sacral artery. Two of the 6 patients underwent Onyx glue embolization,3 were treated with microneurosurgery,and 1 was treated with embolization in combination with microneurosurgery. They were all achieved anatomic cure. The Aminoff & Logue scores were improved after 1 year (3. 8 ± 1. 9 scores before procedure,2. 8 ± 2. 0 scores after procedure),there was no significant difference (P >0. 05). The myodynamia scores were improved in 3 patients,2 did not change,1 got worse. The urinary and bowel functions were improved in 2 patients,and4didnotchange.Conclusion Filumterminalevascularmalformationisararevascular malformation of spinal cord. Both embolization and surgical treatment can achieve anatomic cure. Although the spinal cord function can be only partially restored,but continuous deterioration can be prevented.