成人脂肪瘤型脊髓拴系的外科治疗及疗效分析

Surgical treatment and curative effect on tethered cord syndrome with lipoma in adults

目的探讨成人脂肪瘤型脊髓拴系的手术治疗方法,并对疗效进行分析。方法解放军总医院神经外科于2010年2月-2015年9月收治的成人脂肪瘤型脊髓拴系患者共105例,采用电生理监测、超声吸引装置辅助下显微外科手术治疗,术后随访3个月以上,总结成人脂肪瘤型脊髓拴系的手术方法和注意事项,并对不同症状的预后进行分析。结果全部病例随访3～69个月（平均29.92个月）,手术对于疼痛症状缓解的有效率为74.42%,会阴部或下肢难愈性溃疡、大便症状、肢体感觉、远端肌力和小便症状也有所改善。肌肉萎缩、下肢畸形等症状术后未见明显改善,但无继续进展。结论对于以疼痛、皮肤难愈性溃疡、排便障碍为主要症状或现有症状有加重趋势的成人脂肪瘤型脊髓拴系患者,手术治疗有较高价值。

Objective To explore the surgical treatment of tethered cord syndrome and lipoma in adults and analyze its efficacy.Methods One hundred and five adult patients with tethered spinal cord syndrome and lipoma who were admitted to department of neurosurgery of Chinese PLA General Hospital from February 2010 to September 2015 were included in this study.All patients had undergone microsurgical operation assisted with cavitron ultrasonic surgical aspirator（CUSA） under electrophysiological monitoring.Surgical technology and experiences were introduced.With more than 3 months＇ follow-up,the prognosis of patients with different symptoms was analyzed.Results All patients were followed up for 3 to 69 months（mean 29.92 months）,and the outcomes were divided into five grades of recovery,improvement,stability,degradation,and newly occurrence.The results indicated that the surgical treatment was most effective to pain relief with an efficiency of 74.42%,followed by refractory ulcers of lower limbs and perineum,bowel dysfuction,sensory abnormalities of limbs,muscle strength of extremity limbs and urinary dysfunction.No significant improvement was obtained after surgery in muscle atrophy and deformities of lower limbs,while the existing symptoms maintained without deterioration.Comprehensive analysis confirmed that microsurgical treatment for adult lipoma tethered spinal cord syndrome was still effective.Conclusion For patients of techered cord syndrome and lipmoma with symptoms of pain,skin ulcer and defecation disorder or aggravating trend in existing symptoms,surgical treatment is still of high value.