成人与儿童脊髓拴系综合征的临床特点及手术疗效对比分析

Comparison of clinical characteristics and the therapeutic effects of the tethered cord syndrome( TCS) in adult and children

[目的]通过分析、总结成人与儿童脊髓拴系综合征的临床特点,比较、分析二者的手术疗效。[方法]回顾分析2003年10月~2012年3月就诊于东直门医院骨科的76例脊髓拴系综合征患者,儿童组47例（年龄〈18岁）,年龄8个月~17岁,平均（8.18±5.3）岁;成人组29人（年龄≥18岁）,年龄18~54岁,平均（31.59±11.79）岁。所有患者术前均行影像学和尿流动力学检查（婴幼儿除外）。手术疗效通过患者术前、术后2周、术后3个月及末次随访的神经症状评分进行评估,平均随访时间（60±62）个月。[结果]疼痛是成人组患者最常见的主诉,存在严重神经障碍的患者很少。括约肌功能失调是儿童组患者最常见的主诉。儿童组47例中有44例接受了手术治疗,成人组29例中有24例接受了手术治疗。所有患者术后神经症状的稳定状态都得到了明显改善,儿童组患者术后括约肌功能改善显著,而成人组患者术后疼痛改善更明显。总体来看,两组患者术后3个月、末次随访时神经功能评分分别与术前比较,差异均有统计学意义（P〈0.01）。[结论]儿童脊髓拴系综合征患者一经发现应尽快手术治疗,以防止症状出现和（或）加重。对于神经症状不断发展的成人患者,建议行手术治疗,手术可有效缓解疼痛并延缓神经症状的进展,但手术治疗应慎重,尤其是伴有脂肪瘤和神经管囊肿的复杂成人脊髓拴系综合征患者,应特别注意手术方式及手术策略,由经验丰富的脊柱外科医生完成。同时,建议不存在神经症状的成人患者保守治疗,以保持长期、稳定的神经状态。

[Objective] To analyze and summarize the clinical characteristics of the tethered cord syndrome（ TCS） in adults and children and compare their therapeutic effects after surgery. [Methods] Clinical data of the 76 TCS cases from Oct. 2003 to Mar. 2012 in Orthopedic Department of Dongzhimen Hospital were retrospectively analyzed. There were 47 people in the children group（ age 〈 18 years old）,ranging from 8 months to 17 years and the average age was（ 8. 18 ± 5. 3） years old; 29 people were in the adult group（ aged 18 or higher）,ranging from 18 to 54 years and the average age was（ 31. 59 ± 11. 79） years old. All the patients were taken imaging and urodynamic tests（ except for infants） before surgery. The therapeutic effects were estimated according to the evaluation before surgery,at 2weeks after surgery,3 months after surgery,and last follow- up according to the neurological scoring system. The average duration of follow- up was 60 ~ 62 months. [Results] Pain was the most common chief complain in adults,but few had serious neurological disorders. The sphincter disturbance was the most common chief complain in children. Forty- four out of 47 children and 24 out of 29 adults received surgeries,and all the pain was relieved and their neurological symptoms stability state was obviously improved. The comparison of the therapeutic effects between before surgery and 3 months after surgery,and the neurological scoring between before surgery and last follow- up in two groups showed statistically significant difference（ P 〈 0. 01） respectively. [Conclusion] Children should receive surgery as soon as the TCS is found in order to prevent the symptoms’ occurrence and development. The TCS adults with developing neurological symptoms are suggested to receive surgery to relieve pain and delay the progress of neurological symptoms. However,the surgery should be taken with caution especially on TCS patients with lipoma and neurenteric？ cyst,and performed by experienced spinal surgeons. It is also recommended that TCS adult patients without neurological symptoms receive conservative treatment to maintain a long- term and stable neural state.