儿童背侧型脂肪瘤脊髓栓系综合征的临床分析

Clinical analysis of dorsal type lipoma tethered cord syndrome in children

目的通过对92例儿童背侧型脂肪瘤脊髓栓系综合征（tethered cord syndrome，TCS）临床数据分析，探讨其外科治疗方法及疗效。方法回顾分析重庆医科大学附属儿童医院神经外科2011年5月到2016年3月收治的92例脊髓背侧型脂肪瘤TCS的临床资料，男47例，女45例。年龄：0～〈1岁58例，1～〈3岁21例，3～11岁13例。术中在电生理监测下行显微外科手术治疗。手术方法包括：全椎板切开并保留离断的椎板－棘突，显微镜下切开脂肪瘤表面包膜，用超声吸引器清除脂肪瘤，缝合脂肪包膜、硬脊膜，椎板解剖复位。采用Kirollos术中松解分级和Hoffman功能性分级评估手术疗效。随访时间11～63个月。结果92例背侧型脂肪瘤TCS患儿手术的脂肪瘤全切率为77.1%（71/92），术后椎板解剖复位率为95.6%（88/92），术后的总治愈率为47.2%（43/91），总有效率为87.9%（80/91），并发症率为7.6%（7/92）。全切者、年龄〈3岁者效果更佳，术后尿便功能障碍较下肢功能障碍改善更明显，无神经功能症状的患儿基本能治愈。结论背侧型脂肪瘤TCS采用全椎板并保留离断的椎板－棘突的入路，早期全切脂肪瘤、松解栓系、椎管内膜性结构以及椎管骨性结构解剖复位的治疗原则。术后并发症少，手术有效率高，无症状的患儿治愈率高。

ObjectiveBy analyzing children＇s dorsal type lipoma tethered cord syndrome（TCS） clinical data, we aim to discuss the method and curative effect of surgical treatment.MethodsFrom May 2011 to March 2016, retrospective analyses were performed for 92 cases of dorsal type lipoma TCS. Microsurgical treatment was offered along with intraoperative electrophysiological monitoring. Surgical procedures consisted of whole vertebral plate resection, retaining broken vertebral plate-spine microscopically, cutting spinal canal lipoma surface, ultrasonic aspiration of removed lipoma, capsular lipoma and dura mater of suture and anatomical repositioning vertebral plate. Kirollos and Hoffman grading systems were used for evaluating the efficacy of surgical treatment. The follow-up period ranged from 11 to 63 months.ResultsThe rate of lipoma total resection was 77.1%（71/92）, anatomical repositioning rate of vertebral plate 95.6%（88/92）, total curing rate 47.2%（43/91）, total effective rate 87.9%（80/91） and complication rate 7.6%（7/92）. Children aged under 3 years undergoing total resection had better outcomes. Urinary dysfunction improved more obviously than lower limb dysfunction. Cure might be obtained without neurologic symptoms.ConclusionsThe above treatment is effective with fewer postoperative complications and has a high curing rate in asymptomatic TCS children.