儿童脊髓栓系综合征的诊治与并发症处理

Diagnosis,Treatment and Complication of the Tethered Cord Syndrome in Children

目的报道33例儿童脊髓栓系综合征的诊断、治疗与并发症处理的结果。方法33例患儿主要临床表现有:12例后背或腰骶正中皮肤异常;29例下肢畸形、感觉及运动障碍;11例括约肌功能障碍。32例经X线检查脊柱有畸形;6例CT检查显示骨性脊髓纵裂、脂肪性异常增粗的终丝;11例MRI检查显示有脊髓病变,33例MRI检查均显示有低位脊髓、圆锥位于L3～S1和终丝增粗。33例根据术中病理不同选择不同手术方法:穴1雪切除位于低位圆锥附近的骨性病变,如脊髓纵裂予以切除;穴2雪松解对硬脊膜和脊神经组织的粘连与压迫;穴3雪借助放大镜,尽可能切除椎管内脂肪、纤维瘤组织;穴4雪靠近骶尾部将增粗终丝的止点处结扎、切断。结果30例随访1～12年,平均5年。6例效果好,25例有效,2例效果差。术后并发症:脑脊液漏4例,采取俯卧位、局部加压包扎,或伤口再次缝合治愈。结论MRI结合CT检查,有助对儿童脊髓栓系综合征的评估,手术部位及方法根据病理变化而定,单纯增粗的终丝手术切断效果好。

Objective Case data of 33 children with a tethered cord syndrome were reviewed to evaluate effects of different methods on diagnosis,surgical treatment and its complication. Methods Among 33 case there were 16 male,17 female;age from 2 to 15 years old with an average of 9 years old. The clinical signs were as follows:①skin at the posterior back or lumbosacral centre was abnormal in 12 cases;② deformities,sensory and motion dysfunction of lower limbs in 29 cases;③sphincter disorder in 11 cases.X-ray examination showed spinal deformities in 32 cases;CT examination showed bony diastematomyelia,thickened filum terminale with lipoma in 6 cases;MRI examination showed abnormal spinal cord in 11 cases,there were low position spinar cord,coni at lumbus 3 to sacrum 1 with thickened filum terminale in 33 cases.Surgical method:division of filum terminale in 33 cases,these procedures were different on the basis of pathological findings:(1)Resection of bony deformities around the conus,such as diastematomyelia;(2)To release the adhension and pressure of spinal dura mater and spinal nerve;(3)To remove lipoma in the spinal canal under magnifying glass;(4)division of thickened filum terminale near its end. Complica- tion including 4 cases had CSF leak after the surgery,but given prone position,local increasing pressure bandaging,or surgical repair,they were all healed. Results The postoperative follow-up was 1～12 years with mean 5 years,6 cases showed significant improvement;25 cases were good;2 cases had no changes. Conclusions MRI and CT examination may show definitely the pathological features of the tethered cord syndrome. The operative site and methods should be different according the pathological changes;the effect of division of thickened filum terminale is very good,the surgical doctor should pay more attention to prevent CSF leak after the surgery.