脊髓栓系综合征的手术治疗

SURGICAL TREATMENT FOR TETHERED CORD SYNDROME

目的 :通过分析 31例栓系综合征患者的外科治疗结果 ,探讨脊髓栓系综合征显微外科手术治疗的分级标准。方法 :对 1994～ 2 0 0 1年共收治的 31例脊髓栓系综合征患者 ,术前均行MRI检查确诊。术中均在显微镜下行椎管内病灶切除 ,脊髓栓系松解 ,并根据松解的程度将其分为完全松解 :解除病因 ,完全分离、松解圆锥、马尾束 ,切断终丝 ,完整修复硬膜 ;部份松解 :部分解除病因 ,切断终丝 ,圆锥、马尾束未做到完全松解 ;未松解 :部分解除病因 ,未分离、松解圆锥和马尾束 ,未切断终丝。结果 2 2例完全松解者 ,临床症状缓解的总有效率为86 .6 % ;部分松解者 4例 ,临床症状缓解的总有效率为 5 3.6 % ;无松解者 5例 ,临床症状缓解的总有效率为 9.1%。结论 :建立脊髓栓系综合征显微外科手术治疗的分级标准 ,有利于客观评判手术效果 。

Objective:To study the standard of microsurgical operation grade for tethered cord syndrome through analyzing the operative results of patients with this syndrome.Methods:Thirty-one cases diagnosed by MRI before operation have been treated in our department between 1994 to 2001. The removal of the focus in the vertebral tube and loose of the tethered cord have been carried out by microsurgery. It was divided into 3 grades according to the loosen grade of tethered cord, grade 1: the causes of this diseases have been removed entirely, the adherence around conus medullaris and cauda equina has been loosed completely, and the filum terminale has been cut;grade 2: the causes of the diseases have been removed partially, the adherence around conus medullaris and cauda equina has not been loosed, and the filum terminale has been cut; grade 3:the causes of the diseases have just removed partially and others have not been done any more.Results:There were 22 patients who received grade 1 operation in which the total effective rate of relieving their clinical manifestations was up to 86.6%, 4 cases received the grade 2 operation, their total release rate was 53.6%, and the total release rate of rest 5 patients who just received grade 3 operation was just 9.1%.Conclusions: Setting up the grade standard is useful for objectively evaluating the effects of microsurgery operation that treated the patients who suffered from tethered cord syndrome , and those patients should be treated according to the demand of grade 1.