成人脊髓栓系综合征的诊治

Diagnosis and treatment of tethered cord syndrome in adults

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床特征以指导诊断和治疗。方法报告１８例成人ＴＣＳ的诊治情况。患者均经ＭＲＩ证实并行手术松解；根据手术所见和影像学分析其致病机理及手术要点。结果栓系原因分别为椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月至５年随访，其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ；术中应避免损伤圆锥和马尾神经；

Objective To study the clinical characteristics of tethered cord syndrome (TCS) in adults. Method 18 patients with TCS were confirmed by preoperative MRI and were operated on for releasing of tethered conus. Pathological mechanism and main points of operation were analysed according to the operative findings and radiological data. Result The cord or conus were tethered by intradural tumors (6 patients),myelomeningocele (6),thickened filum terminale (3),diastematomyelia (2) and adhesion after operation (1).14 of the 18 patients showed good results after follow up for 8 months to 5 years. Conclusion Clinical manifestation and prognosis of TCS in adults are different from those of TCS in children.Attention should be paid to avoid additional injury to the conus and cauda equina during operation.The long course of diseose and retethering of the conus lead to poor outcome.