成年人脂肪瘤型脊髓栓系综合征的手术疗效分析

Analysis of surgical effect of adult lipomatous tethered cord syndrome

目的探讨成年人脂肪瘤型脊髓栓系综合征（TCS）的手术疗效。方法对29例脂肪瘤型TCS的成年患者进行回顾性研究。男11例，女18例。年龄20～59岁。所有患者均行终丝松解和脂肪瘤切除术。根据Hoffman功能分级评价患者术后下肢肌力及大小便改善情况，采用视觉模拟评分法（VAS）评估患者腰痛情况。结果根据Hoffman功能分级：术后有9例下肢肌无力明显改善，其中1例小便障碍明显改善，腰骶部疼痛的术前VAS评分（8．67±0．30）分，术后VAS评分（2．63±1．30）分，术前、术后比较差异有统计学意义（P〈0．05）。结论终丝松解和脂肪瘤切除术能有效地改善成年脂肪瘤型TCS患者的腰骶部疼痛症状，同时下肢肌无力也可得到适当缓解，但大小便障碍改善不明显。

Objective To discuss the surgical effect of adult lipomatous tethered cord syndrome （TCS）. Methods The clinical data of 29 patients with adult lipomatous TCS were systematically analyzed. Eleven of male and 18 of female, who ranged from 20 to 59 years. All patients were performed filum terminale release and lipoma excision, the clinical outcome after operation was analyzed according to Hoffman grading criteria and visual analog scale （VAS）. Results According to Hoffman grading criteria, 9 cases were obviously improved in leg muscle weakness, including 1 case with urination disturbance improved significantly. Also the lower back pain of patients were improved obviously： （2.63 ~ 1.30） scores vs. （8.67 ：i= 0.30） scores, there was significant difference （P 〈 0.05）. Conclusions Filum terminale release and lipoma excision can effectively improve the symptom of lower back pain of adult lipomatous TCS patients, meanwhile the symptom of paraparesis can improve appropriate postoperatively. But urinary deficits do not show a significant change.