终丝切断造瘘术治疗脊髓拴系合并末端脊髓空洞的疗效分析

Filum terminale section and fistulation in the treatment of tethered cord syndrome combined with caudal syringomyelia of medulla spinalis

目的探讨脊髓拴系合并末端脊髓空洞的临床特点,采用终丝切断造瘘的手术方式对其进行治疗并分析疗效。方法回顾性分析我院2011年1月至2018年12月收治的12例脊髓拴系合并末端空洞患者的临床资料。12例患者的空洞均向远端延伸形成终丝空洞,其中空洞位于腰骶部6例、胸腰骶部4例、颈胸腰骶(全脊髓) 2例;临床症状多表现为大小便功能和下肢远端感觉运动障碍,可合并脊柱侧弯、脊柱裂、脊髓纵裂和皮毛窦等其他神经管畸形。手术在显微镜下进行,采用终丝切断造瘘术,先游离并切断终丝,松解脊髓拴系,然后在切断的终丝末端做"V"型造瘘,达到引流脊髓空洞积水、防止空洞远端开口闭合的目的。根据脊柱裂神经功能量表记录患者术前及术后随访的运动功能、反射和大小便功能,通过神经功能评分和分级来评价手术效果。结果术后随访3个月至6年,全部病例空洞明显缩小或消失,临床症状均有不同程度改善,空洞无复发。结论对脊髓拴系合并末端空洞的患者采用终丝切断造瘘的手术方式治疗,创伤小,效果良好,可有效避免空洞复发。

Objective To describe the clinical features of tethered cord syndrome combined with caudal syringomyelia of medulla spinalis,and to explore the therapeutic effect of filum terminale section and fistulation. Methods Medical records were reviewed in 12 patients of tethered cord syndrome combined with caudal syringomyelia who underwent surgical intervention in our department from January 2011 to December 2018. The syringomyelia in all cases extended caudally to form filum terminale syringomyelia. Preoperative MRI imaging revealed that there were 6 patients of lumbosacral syringomyelia,4 patients of thoracolumbosacral syringomyelia and 2 patients of cervical to lumbosacral syringomyelia. Clinical manifestation involved bladder/bowel dysfunction and sensorimotor disturbances of lower extremities. Other complicated neural tube defects included scoliosis,spina bifida,diastematomyelia and dermal sinus. Under microscopic view,filum terminale sectioning and tethered cord releasing were firstly performed,followed by inverted "V"-shaped incision made on the caudal end of filum terminale,for syrinx cavity shunt and prevention of incision occlusion. Curative effects were measured before and after surgery by Spina Bifida Neurological Scale based on sensory and motor functions,reflexes,and bladder and bowel function. Results Syrinx cavities in all cases shrank or disappeared during the follow-up of 3 to 6 months,and symptoms significantly ameliorated without relapses. Conclusion Patients of tethered cord syn- drome combined with caudal syringomyelia responded well to filum terminale section and fistulation,which is a minimal invasive procedure with good surgical outcomes.