痉挛型脑瘫合并脊髓栓系综合征Ⅰ期显微外科手术治疗的长期随访

Long-term follow-up of stage Ⅰ microsurgery for the treatment of spastic cerebral palsy with tethered cord syndrome

目的探讨Ⅰ期显微外科手术治疗痉挛型脑瘫合并脊髓栓系综合征（TCS）的疗效。方法回顾性分析50例痉挛型脑瘫合并TCS病人的临床资料,均行Ⅰ期显微外科手术治疗,即选择性腰骶段脊神经后根部分切断术（SPR）、硬脊膜囊尾端松解术及内外终丝切断术。结果所有病人随访36-130个月,平均65个月。下肢痉挛缓解率为100%,步态功能改善率为92%,小便功能改善率为77.4%,大便功能改善率为73.7%,生活质量提高率为100%。术后并发症：下肢感觉障碍18侧,肌无力15侧,长期腰痛5例,随访期间均好转;大小便功能障碍加重2例,随访期间稍改善。结论显微外科Ⅰ期手术治疗痉挛型脑瘫合并TCS,可同时缓解下肢痉挛状态和改善大小便功能,是安全、有效的术式。

Objective To study the curative effect of stage Ⅰmicrosurgery for the treatment of spastic cerebral palsy with tethered cord syndrome （TCS）. Methods Clinical data of 50 patients with spastic cerebral palsy associated with TCS were analyzed retrospectively. The stage Ⅰ microsurgery including selective posterior rhizotomy （SPR） of lumbosacral region, lysis of dural sac tail end and external and internal filum terminale amputation was performed in all the patients. Results All the patients were followed up for mean period of 65 months, ranged from 36 to 130 months. The remission rate was 100% in spasticity of lower limbs, 92% in gait function, 77.4% in urinary function and 73.7% in defecatory function. The improvement rate of life quality was 100%. The postoperative complications included sensory disturbance of lower limbs in 18 sides, muscle weakness in 15 sides and long-term lumbago in 5 cases, and all the complications improved during follow-up period. The urinary and defecatory dysftmction occurred in 2 cases postoperatively and improved slightly during follow-up period. Conclusions The stage Ⅰ mierosurgery is an effective and safe method for the treatment of spastic cerebral palsy with TCS, and can also relieve spasticity of lower limbs and improve urinary and defecated function.