复杂脊髓拴系综合征的手术疗效分析

Analysis of surgical efficacy of complex tethered cord syndrome

目的探讨不同类型复杂脊髓拴系综合征的手术时机、方式和疗效。方法回顾性分析兰州大学第二医院自2011年1月~2017年4月收治的154例复杂脊髓拴系综合征患者的资料。按照患者性别、年龄、拴系发生部位及病理表现进行分类。所有患者均接受电生理神经功能监测辅助下的显微外科手术,术中拴系松解程度采用Kirollos和Van-Hille分级;术后依据Hoffman神经功能分级评判疗效。结果手术无死亡病例,术中完全松解率97%。对其中126例患者随访3个月~3.8年。依据Hoffman神经功能分级,术前分级0~3级的患者术后症状改善率显著高于4~5级患者;有1例术后症状加重,其余患者症状或体征均有不同程度改善。结论复杂脊髓拴系综合征的诊断和治疗非常复杂和困难,手术难度较大,传统手术后神经功能障碍的发生率高。对于该病患者,确诊后应尽早行手术治疗。在术中应用手术显微镜及电生理神经功能监测,可以有效降低脊髓及神经损害,提高手术的效果和安全性。

Objective Different types of surgery for complex tethered cord syndrome（ TCS） were summarized and analyzed to explore the surgical time,method and efficacy,so as to improve the outcome of this disease. Methods The clinical data of 154 patients with complex TCS admitted in our department from January 2011 to April 2017 were analyzed retrospectively,and were classified based on gender,age,the sites of tethered cord and the pathological manifestations. All patients received intraoperative neuromonitoring assisted microsurgery,and the intraoperative release degree of tethering was classified using Kirollos and Van-Hille. During postoperative follow-up,clinical efficacy was evaluated based on Hoffman nerve function classification. Results There was no operative death.Intraoperative complete release rate was 97%. Of 154 patients,126 were followed up from 3 months to 3. 8 years. According to Hoffman nerve function classification,the symptom of patients who were classified into class 0-3 before operation was markedly improved after operation than those in class 4-5. One of the patients had disease progression after operation,while the rest had symptoms or signs improved to different extent. Conclusions The diagnosis and treatment of complex TCS is a complicated and challenging task with great surgical difficulty,and the occurrence rate of dysneuria is relatively high after regular surgery. As to this disease,surgery should be conducted immediately after it is diagnosed. The intraoperative application of microsurgery and neuromonitoring can effectively reduce the damage to spinal cord and nerve,and improve surgical outcomes.