儿童脂肪瘤型脊髓拴系综合征的手术治疗

Surgical treatment of lipoma type tethered cord syndrome in children

目的探讨儿童脂肪瘤型脊髓拴系综合征（TCS）的手术治疗方法及其疗效。方法回顾性分析2008年1月至2015年1月解放军总医院神经外科收治的245例儿童脂肪瘤型TCS患者的临床资料。根据MRI表现将245例患者分为四种类型：背侧型、尾侧型、混杂型以及脂肪脊髓脊膜膨出型。全部病例均行显微手术治疗。采用脊柱裂神经功能量表（SBNS）评估手术疗效。随访时间为6～60个月。结果245例脂肪瘤型TCS患儿的术后总有效率为76．0％。各型脂肪瘤型TCS中，背侧型疗效最佳，然后依次为尾侧型、脂肪脊髓脊膜膨出型和混杂型。全切除（近全切除）组较大部切除组效果更佳。结论脂肪瘤型TCS确诊后行早期手术治疗可防止或减轻患儿生长发育后出现的大小便和双下肢功能障碍。手术应力争全切除或近全切除脂肪瘤，获得脊髓和马尾神经的完全松解，以达到良好的疗效。影响手术疗效的主要因素为脂肪瘤的类型、手术时机、术前症状、神经松解是否彻底和再栓系。

Objective To investigate the surgical treatment and its efficacy of lipoma type tethered cord syndrome （TCS） in children. Methods The clinical data of 245 children with lipoma type TCS admitted to the Department of Neurosurgery, Chinese PLA General Hospital from January 2008 to January 2015 were analyzed retrospectively. According to the imaging findings, the 245 children were divided into four types： dorsal type, caudal type, chaotic type, lipo-myelomeningocele type. All the children were treated with microsurgery. Spina bifida neurological scale （SBNS） was used to evaluate the efficacy of surgical treatment. The follow-up time ranged from 6 to 60 months. Results The total effective rate of 245 children with lipoma type TCS after procedure was 76. 0%. Among all types of TCS, the effect of dorsal type was best, and then followed by caudal type, lipo-myelomeningoeele type, and chaotic type. The effect of total resection （ near total resection） group was better than the subtotal resection group. Conclusions Once the lipoma type TCS is diagnosed, early surgery can prevent or reduce the defecation dysfunction and both lower extremity dysfunction after the growth and development of children. Surgery should strive to total or subtotal resection of lipomas in order to complete release of the spinal cord and cauda equine. The main factors for influencing the operative effect and prognosis were the types of lipomas, timing of operation, preoperative symptoms, complete neurolysis or not, and having retethering or not.