儿童和成人脊髓栓系术前术后临床特点

Analysis on clinical manifestation between adolescent and adult patients with tethered cord syndrome

目的探讨儿童和成人脊髓栓系不同的临床表现,认识这种疾病的发生和发展过程。评估这种疾病对神经功能的伤害,掌握他们的临床特点和手术后远期意义。方法 142例脊髓栓系患者分成两组,2～14岁为儿童组,15～67岁为成人组。从症状开始到手术平均间隔6年。根据术前术后尿功能障碍,腿脚畸形,双下肢肌力下降,感觉异常,进行比较。也通过术前术后X线、MRI、CT、尿动力学及膀胱残余尿的测定,术中电生理的监测,以及长期随访进行评估。结果在儿童组中,有27例尿功能障碍的患者,术后有16例有轻微改善,29例腿脚的畸形通过长期随访有22例术后停止了发展,双下肢肌力下降的38例儿童,31例改善。术前双下肢和肛周感觉减退47例,术后39例改善。成人脊髓栓系临床表现相对较轻,手术后改善明显。83例尿功能障碍的患者,52例术后缓解。77例术前双下肢肌力降低,有56例术后改善。56例术前双下肢和肛周感觉减退,术后43例改善。腿脚畸形方面,儿童改善好于成人。结论通过外科治疗结果的回顾性探讨,成人组与儿童组的比较,成人尿功能障碍略好于儿童。在肌力改善方面、在腿脚畸形方面,儿童组好于成人组。而在双下肢和肛周感觉方面,儿童稍好于成人。脊髓松解期间术中电生理监测,对预防加重神经损伤有重要意义。

Objective According to analysis on difference clinical manifestation between adolescent and adult patients with tethered cord syndrome,the process from generation to progression in the disease was inquired into.According to evaluation on nervous disorders from the disease,clinical characters and prognosis significance for the disease were judged and mastered.Methods 142 patients with tethered cord syndrome were grouped into adolescent（less than 14-year-old） and adult（more than 15-year-old） in our study.The average internal period from initial symptoms to operation was 6 years.The disorder of urine,deform of lower legs and foots,weakness of bilateral lower extremities,sensation dysfunction were compared with between two groups.The X-ray,MRI scan,urine dynamics,remained urine of bladder,and monitor of electrophysiology on time were compared with between preoperative and postoperative,and were evaluated long-time follow-up.Results In adolescent group,there are 16（59.3%） cases obtained improvement after operation in 27 cases suffered urinary dysfunction.The deform of legs and foots was interrupted in 22（43.1%） cases from 29 suffered the progressing deformation.The muscle strength was improved in 31（81.5%） cases postoperative from 38 cases suffered legs weakness.The improvement of sensation was obtained in 39（82.9%） cases from 47 cases suffered sensation dysfunction.In adult group,there are 52（62.7%） cases obtained improvement after operation in 83 cases suffered urinary dysfunction.The muscle strength was improved in 56（72.7%） cases postoperative from 77 cases suffered legs weakness.The improvement of sensation was obtained in 43（76.9%） cases from 56 cases suffered sensation dysfunction.Conclusions In urine dysfunction,the improving rate in adult was higher than in adolescent.In muscle strength,deform of legs and foots,and sensation dysfunction,the improving rate in adolescent was higher than in adult.In additional,intra-operative electrophysiological monitoring prevented the nervous from injury,the satisfied outcome and prognosis were obtained by open operation.