75例儿童脊髓纵裂Ⅰ型的显微外科治疗

Microsurgical treatment of type I diastematomyelia in 75 children

目的通过对75例儿童脊髓纵裂I型临床资料分析，评价其显微外科治疗疗效。方法患者术前均行神经系统检查、MRI检查以及CT检查，并经显微外科手术治疗，手术中综合运用电生理检测、气动磨钻及显微镜等设备。手术前后相应地应用尿动力学，神经电生理等检查方法。术后疗效根据临床症状、尿动力学和神经电生理等结果进行对比评定。结果根据程斌等提出的临床疗效：本组75例患儿中，术后疗效优（痊愈）1例，良（显效）30例，可（有效）40例，差（无效）4例，总有效率94．6％。膀胱顺应性降低在术前和术后差异有统计学意义（P〈0．05）。神经电生理检查在术前和术后差异有统计学意义（P〈0．05）。结论显微外科手术治疗儿童脊髓纵裂I型可获得较好的疗效，并结合应用神经电生理监测和气动磨钻。

Objective To evaluate the therapeutic effect of microsurgicaltreatment for childrenwith type I diastematomyelia. Methods The clinical data of 75 cases including neurological examination, MRI and three dimensional CT reconstruction were collected. The microsurgical treatment of type I diastematomyeliawas performed in all patients. Neurological examination, high- speed bone drill and microscope were used during operation. Electrophysiological examination was performed before and after surgery. The microsurgical treatment of Lipoma Tethered cord syndromewas performed in all cases and the therapeutic effectiveness after operation was analyzed according to clinical symptoms, urodynamicalexamination and electrophysiological examination inthe patients. Results According to Cheng - bin grading system, the short term effects were assessedas following： recovery in 7 cases, excellent in 24, effective in 40 and ineffective in 4. The markedly effective rate was 94. 6% . There were significant differences in urodynamicalexamination between presurgery and postsurgery. There was significant difference in electrophysiologicalexamination between presurgery and postsurgery. Conclusions The microsurgery should be performed on tethered cord syndrome as soon as possible. The application of intraoperative neuroelectrophysiological monitoring and high - speed bone drill can be used for type I diastematomyeliain children.