超声观察圆锥运动在脊髓栓系综合征诊断及随访中的意义

Significance of Cord Motion by Ultrasonography Observation on Diagnosis and Follow-up in Tethered Cord Syndrome

目的研究圆锥运动在脊髓栓系综合征(TCS)诊断及术后随访中的作用,以便指导TCS的诊断、术后随访及复发患儿的诊断。方法对年龄小于3岁的59例TCS患儿术前术后均利用超声观察圆锥运动,将圆锥运动的强弱与术前症状的出现、术后症状缓解、消失、复发等的关系进行比较分析。结果术前圆锥搏动正常的患儿无大小便及双下肢障碍,术前圆锥搏动减弱或消失的患儿易伴有大小便或双下肢功能障碍,术中观察圆锥与术前超声观察基本一致。术后圆锥搏动异常者,大小便或双下肢常有症状,圆锥搏动正常者,绝大多数症状消失或好转,圆锥搏动从正常到异常转化者症状往往复发。术前圆锥既无搏动又不随呼吸运动者术后预后差。结论超声观察圆锥运动是诊断、随访TCS的最好方法,既可预测疗效,又可对复发的患儿早期诊断。

Objective Features of cord motion were observed by ultrasonography, in order to evaluate the outcome of diagnosis and follow-up postoperation in tethered cord syndrome(TCS). Methods Cord motion for 59 children with TCS, whose age was low than 3 years, were observed by ultrasonography preoperatively and postoperatively, and the intensity of conus medullaries motion than was compared with preoperative appearance and reduction, disappearance and relapse of symptoms postoperatively. Results The children of normal conus motion had no disorders of defecation and urination and lower limbs symptoms, but abnormal conus motion had these symptoms in the preoperation. The conus motion observed using ultrasonography preoperatively was as same as the that saw by bared eyes during the operation. Postoperatively, the children with possessing unusual conus pulsation had symptoms of dysporia and paruria or functional obstruction of low limbs, and the most children with normal conus pulse, their symptoms disappearance or remission. The conus pulsation change from normal to abnormal indicated the relapse of symptoms after the operation. The conus possessing neither pulse caused by heart nor motion caused by breath in preoperation, these patients their prognosis was bad. Conclusions Examining conus motion by ultrasonography is the best way for diagnosis and follow-up in TCS, it not only can predict the outcome of the operation but early diagnose the relapsed TCS after the operation early also.