显微松解术治疗儿童脊髓栓系综合征疗效分析

Microsurgical release of tethered spinal cord in pediatric patients： analysis on therapeutic effects

目的总结分析儿童脊髓栓系的显微松解手术效果。方法西安西京医院2007年1月至2011年12月收治脊髓圆锥和马尾部神经症状患儿80例。M砌显示全部病例伴有腰骶椎板缺如、脊髓低位、终丝增粗、脊髓末端占位。接受脊髓栓系松解手术（包括脊膜膨出囊和腰骶椎管内病变切除），28例患儿术中获得脊髓圆锥和马尾神经电生理监测，术后对67例患儿随访。结果患儿术后住院期内自述症状缓解或减轻者69％（55／80）。大、小便异常的患儿中，术后改善者占62％（40／65）；下肢感觉、运动以及发育和营养症状40例中，18例术后早期下肢感觉功能好转（45％），11例运动障碍出现改善（28％）。随访时大小便功能较术前明显改善者占79％（45／57）；下肢感觉和运动障碍较术前明显改善者占63％（22／35）；术中接受脊髓圆锥和马尾神经电生理监测的患儿，比未接受监测者，自评症状改善率明显增加。结论显微分离技术和神经电生理监测手段，是保障松解手术效果的关键因素。

Objective To summarize and analyze the therapeutic effects of microsurgical release on pediatric patients with tethered spinal cord. Methods Eighty hospitalized patients with conus and cauda equina symptoms were included in this study. Their MRI showed lumbosacral laminectomy defect, spinal low, terminal filament thickening and spinal cord end mass. All cases received microsurgical release operation including resection of the meningocele sac and lumbosacral intraspinal lesion. Among which, 28 patients underwent the electrophysiological monitoring for the functions of conus and cauda equine in operation. Post - operational follow - up were obtained for 67 cases. Results The 69% children self - evaluated an alleviation and mitigation for their symptoms. The 62% cases improved in the cases with abnormality of defecation and urination. Among those with sensory, motor, lower extremities development and nutrition disorders, 45% improved sensory functions and 28% motor functions. The follow -up showed that 79% self-evaluated significant improvements in defecation and urination post -operationally than pre -operationally, and 63% claimed significant improvements in sensory and motor functions. The symptomatic improvement rate by self - evaluation was significantly higher in those who obtained intra - operational electrophysiological monitoring than those who did not. Conclusion The microdissection technique and neural electrophysiological monitoring method are key factors for obtaining better therapeutic effects of microsurgical release on pediatric patients with tethered spinal cord.