摘要目的 探讨伴有脊髓空洞的脊柱侧凸的临床特征及手术策略.方法 回顾2003年1月至2010年11月收治的脊柱侧凸合并脊髓空洞患者50例,按手术方案分为两组:A组,脊柱矫形手术前先行外科手术处理脊髓空洞,之后再行侧凸矫形术；B组,直接进行脊柱侧凸矫形术.分别测量术前、术后及末次随访时冠状面主弯Cobb角、矢状面胸后凸Cobb角,术前及术后主弯顶椎偏距、顶椎旋转度及躯干偏移,分析冠状面主弯的矫形率、矫形丢失率,并比较A、B两组的矫形效果和术后并发症的发生情况.结果 两组患者均采用后路椎弓根钉棒系统进行侧弯矫形固定融合术,术后全部病例获得随访,平均随访时间为32.1个月.术前42例患者存在不同程度的症状或体征,术后3例患者肌力或腱反射得到改善.术后冠状面主弯平均矫形率为65.7％,末次随访时丢失2.6°,平均矫形丢失率为6.4％.术后主弯顶椎偏距、顶椎旋转度平均改善63.0％、60.0％,而躯干偏移较术前平均增加0.4 cm.对比A、B两组治疗效果,其术后矫形率及并发症发生率差异均无统计学意义(均P＞0.05).结论 伴脊髓空洞的脊柱侧凸手术矫形只要手术操作得当,术中注意加强脊髓监护,可以获得满意效果；且术前不对脊髓空洞进行预防性外科处理,并不一定增加其术后并发症的发生率.

abstractsObjective To explore the clinical manifestations and surgical strategies of scoliosis associated with syringomyelia.Methods A total of 50 cases diagnosed as scoliosis with syringomyelia between January 2003 and November 2010 were recruited.They were divided into 2 groups:Group A,neurosurgery before scoliosis correction,including suboccipital decompression and syrinx shunting; Group B,one-staged posterior correction and instrumentation without previous neurosurgery.The preoperative,postoperative and last follow-ups of Cobb angle of coronal main curve and thoracic kyphosis were measured.Also the preoperative and postoperative apical vertebra translation,apical vertebra rotation and trunk shift were measured by the same person.The surgical efficacies and complications of correction were compared between 2 groups.Results All patients underwent posterior pedicle screw instrumentation and had a meam follow-up period of 32.1 months.Among them,42 patients had clinical symptoms or signs preoperatively and 3 patients improved postoperatively.The mean correction of coronal curve was 65.7％ and a mean loss of correction 6.4％ during the follow-up.The mean correction of apical vertebra translation and apical vertebra rotation were 63.0％ and 60.0％ respectively.However,the trunk shift increased 0.4 cm.There were no statistically significant differences for the correction efficacies and complications between 2groups (P ＞ 0.05).Conclusion Scoliosis associated with syringomyelia may be effectively managed if a surgeon manipulates carefully intraoperatively and perioperative spinal monitoring is practiced.Furthermore syrinx will not increase the incidence of postoperative complications without prophylactic neurosurgery.