成人脊髓栓系综合征的手术治疗

Surgical treatment on adult tethered cord syndrome

目的探讨成人脊髓栓系综合征的手术治疗效果。方法回顾性分析2005年3月至2013年12月手术治疗的41例成人脊髓栓系综合征患者，其中男17例（41％），女24例（59％）；平均31．6岁，平均病程6．7年。41例均采用神经电生理监测辅助显微外科手术。术后坚持随访，平均2．5年，并应用Hoffman功能分级评价手术疗效。结果所有患者均获得随访，无死亡病例，根据Hoffman功能分级，症状改善11例（27％），稳定30例（73％）。其中，5例脂肪瘤型脊髓栓系，症状改善1例；16例皮样囊肿及表皮样囊肿造成的脊髓栓系，症状改善3例；20例无占位病变性脊髓栓系，症状改善7例，均无加重病例。结论成人脊髓栓系综合征患者手术治疗可以改善症状，其效果与病程相关，早期治疗效果更佳。

Objective To discuss the effects of surgical treatment on adult tethered cord syndrome. Methods The data of 41 adult tethered cord syndrome patients who had been treated with surgery in neurosurgery department of Peking Union Medical College Hospital from 2005 to 2013 were retrospectively analyzed. There were 17 （41%） male patients and 24（59% ） female. The mean age of the patients was 31.6 years old and the mean history of the disease was 6.7 years. 41 patients had all been treated with microsurgery under neurophysiological monitoring. All patients had been followed -up with a mean duration of 2. 5 years and the surgical effects were judged according to Hoffman grading system. Results All patients were followed -up. According to Hoffman grading system, the neurologic symptoms were improved in 11 patients （27%）, maintained in 30 （73%）. Of 5 cases with lipoma tethered spinal cord, the symptoms were improved in t cases. Of 16 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst, the symptoms were improved in 3 cases. Of 20 cases without occupying lesions of tethered spinal cord, the symptoms were improved in 7 cases. And there was no deteriorated case. Conclusions Surgical treatment on patients who had adult tethered cord syndrome could improve the neurologic deficits. The effects were related to the history of disease. Better prognosis could be gained by earlier treatment.