小儿脊髓栓系综合征合并脊髓空洞症行空洞切开引流术疗效分析

Treatment of pediatric tethered cord syndrome with syringomyelia

目的 探讨小儿脊髓栓系综合征合并脊髓空洞症行空洞切开引流术疗效分析.方法 回顾性分析2003年1月至2010年1月经手术治疗合并脊髓空洞症的脊髓栓系综合征患儿40例的临床资料.其中,行脊髓栓系松解术20例（Ⅰ组）,行栓系松解的同时根据脊髓空洞位置行脊髓空洞切开引流术20例（Ⅱ组）.结果 全部40例患儿中,脊髓空洞症位于颈段5例,胸段10例,胸腰段15例,腰段10例.根据MRI轴位像上囊腔最大的横截面空洞的面积占脊髓面积的百分比计算空洞指数,其中空洞指数＜0.4的有14例,空洞指数≥0.4的有26例.术后随访2年以上,MRI检查显示30例（75％）空洞腔缩小,10例（25％）无变化.根据Klekamp and Samii评分法从感觉障碍、运动功能及括约肌症状3个方面评价患儿的治疗效果,Ⅰ组20例患儿的感觉障碍、运动功能及括约肌症状的改善率分别为55％（11/20）、50％（10/20）和45％（9/20）,Ⅱ组患儿的感觉障碍、运动功能及括约肌症状的改善率分别为85％（17/20）、65％（13/20）和75％（15/20）.两组感觉障碍和括约肌症状的改善率比较,差异有统计学意义（P值分别为0.032和0.035）；而运动功能的改善率比较,差异无统计学意义（P=0.42）.结论 对于患有脊髓栓系综合征合并脊髓空洞的患儿,应在脊髓栓系松解同时行显微镜下脊髓空洞切开引流术.对感觉障碍、括约肌症状的改善有肯定疗效.

Objective To explore the efficacy of pediatric tethered cord syndrome and syringomyelia with incision drainage.Methods Retrospective analyses were conducted for 40 surgical children of tethered cord syndrome with syringomyelia.They underwent spinal cord tie-down release （A,n =20） and tie-down release plus incision drainage （B,n =20）.Results The involved segments were cervical （n =5）,thoracic （n =10）,thoracolumbar （n =15） and lumbar （n =10）.The void index （axis as the largest cross section of hollow area percentage of spinal cord area） was 〈0.4 （n =14） and ≥0.4 （n =26）.The follow-up period was over 2 years.On magnetic resonance imaging （MRI）,hollow cavity narrowed （n =30,75%） and there was no change （n =10,25%）.According to the Klekamp and Samii evaluation method,the efficacies were evaluated from three aspects of sensory disorder,motor function and sphincter symptoms.The improvement ratios of there aspects were 55 % （11/20）,50%（10/20） and 45%（9/20） in group A versus 85%（17/20）,65%（13/20） and 75%（15/ 20） in group B respectively.There was statistical significance between two groups in the improvement ratios of sensory disorder and sphincter symptoms （P〈0.05） while the improvement ratio of motor symptoms showed no statistical difference （P〉0.05）.Conclusions Pediatric tethered cord syndrome with syringomyelia should be managed with spinal cord tie-down release plus syringomyelia incision drainage under microscope.And efficacies are definite for improving both sensory disorder and sphincter symptoms.