脊髓纵裂畸形的外科治疗

Surgical treatment of split cord malformation

目的探讨脊髓纵裂的外科治疗。方法回顾性分析2005年1月-2009年1月收治的21例脊髓纵裂患者。男性9例,女性12例。依照脊髓纵裂Pang分型,Ⅰ型12例,Ⅱ型9例。纵裂位于胸段6例,胸腰段6例,腰段7例,腰骶段2例。21例中12例I型SCM患者行骨嵴切除、硬膜囊成型和终丝切断;5例II型SCM患者行纵裂纤维束松解1例,终丝切断术4例。结果17例手术患者15例获3～48个月(平均15个月)随访,术前症状得到明显改善5例,部分改善6例,无变化4例,加重0例。结论I型SCM患者应早期手术治疗,即使无症状也建议手术;II型SCM患者手术适用于有进展性神经功能障碍者,手术方式应针对造成脊髓栓系的原因行纤维束松解或终丝切断术。

Objective To study the surgical treatment of split cord malformation （SCM）. Methods Twenty-one cases of SCM （9 males and 12 females） admitted to our department in January 2005-January 2009 were retrospectively analyzed. Twelve cases were diagnosed with type I SCM and 9 with type II SCM, respectively, following Pang classification. Longitutinal fissure was located in thoracic, thoracolumbar, lumbar, and lumbosacral segments of 6, 6, 7, and 2 cases, respectively. Excision of bony crest and filum terminale, reshaping of dura mater cyst were performed in 12 cases of type I SCM, while release of fiber bundles and excision of filum terminale were performed in 1 and 4 cases of type II SCM, respectively. Results Of the 17 cases undergone surgery, 15 were followed up for 3-48 months （averaged 15 months）. Significant, partial, and no improvement in symptoms was found in 5, 6, and 4 cases, respectively, with no exacerbation of symptoms observed in any case. Conclusion Early surgery should be considered for all cases of type I SCM, even for the asymptomatic cases. The indication for type II SCM patients is progressive neurological dysfunction, and release of fiber bundles or excision of filum terminale should be selected according to the different causes for tethered spinal cord.