儿童脊髓栓系综合征的手术治疗

Surgical treatment of tethered cord syndrome in children

目的探讨儿童脊髓栓系的临床特点、治疗方法、效果和预后。方法回顾性分析30例显微手术治疗的脊髓栓系病儿的临床资料。结果临床病理诊断：脂肪瘤型10例，非脂肪瘤型20例。术后随访O．5～4年，所有病儿局部皮肤包块和窦道畸形治愈，运动功能改善9例，感觉功能改善4例，二便功能改善5例。术后并发症：伤口愈合困难4例，新发小便困难1例，下肢麻木2例；1～3个月均恢复。所有病例无远期并发症。结论儿童脊髓栓系常合并先天畸形，多数病儿早期手术治疗能取得较好的预后。二便功能恢复较下肢感觉运动功能改善更为困难。

Objective To explore the clinical features, treatment method, surgical outcome and prognosis of pediatric tethered cord syndrome （TCS）. Methods Clinical data of 30 children with TCS undergoing microsurgery was analyzed retrospectively. Results The clinical pathological diagnosis showed lipoma type in 10 patients and non-lipoma type in 20. During the follow-up period of 0.5 to 4 years, the local phyma and malformation of the sinus tract were cured in all the patients, the motor function was improved in 9, sensory function improved in 5 and fecal and urinary dysfunction improved in 5. The postoperative compilations included wound healing difficulty in 4 patients, dysuria in 1 and numbness of lower limb in 2, and all the patients recovered well 1 to 3 months after operation. No long-term complications occurred. Conclusions Pediatric TCS is frequently associated with congenital malformation. Most of them could get good prognosis from early operation. The recovery of fecal and urinary function is more difficult than improvement of motor and sensory function.