小切口松解手术治疗儿童单纯脊髓拴系综合征的疗效

Efficacy of small-incision untethering surgery on tethered cord syndrome in children

目的探讨小切口松解手术治疗儿童单纯脊髓拴系综合征(TSC)的安全性和有效性。方法回顾性选择2015年5月至2018年5月浙江大学医学院附属儿童医院神经外科采用松解手术治疗的单纯TSC患儿,所有患儿均为仅需行终丝切断术者,共72例。其中采用小切口手术者33例(小切口组),传统手术者39例(传统组)。比较两组患儿的术中切口大小、术后并发症、住院时间及疗效。结果72例患儿均顺利完成手术,小切口组无一例患儿需要术中延长切口。小切口组和传统组切口长度分别为(2.5±0.3)、(4.8±1.9)cm,住院时间分别为(4.4±1.8)、(6.7±2.6)d,差异均有统计学意义(均P<0.01);传统组共5例(12.8%)发生手术相关并发症,其中切口感染2例,脑脊液漏1例,需药物干预的疼痛2例;小切口组仅1例(3.0%,1/33)发生需药物干预的疼痛。术后6个月小切口组与传统组的治疗有效率分别为93.9%(31/33)、92.3%(36/39),差异无统计学意义(P>0.05);在随访终点,小切口组(>6~27个月)总有效率为93.9%(31/33),传统组(>6~41个月)为89.7%(35/39),差异无统计学意义(P>0.05)。结论与传统的松解手术比较,小切口显微手术治疗仅需行终丝切断术的儿童单纯TSC的疗效相当;具有创伤小、住院时间短等优势。

Objective To explore the efficacy and safety of small-incision untethering surgery in the treatment of tethered cord syndrome(TCS)in children.Methods We retrospectively collected the clinical data of TCS patients who underwent merely untethering surgery at Department of Neurosurgery,Children′s Hospital,Zhejiang University School of Medicine from May 2015 to May 2018.A total of 72 cases were included and all required transection of merely terminal filament.Among them,there were 33 patients undergoing small-incision operation(small-incision group)and 39 undergoing traditional surgery(traditional group).Comparative analysis of intraoperative incision size,postoperative complications,length of stay and postoperative treatment effect were implemented in both groups.Results All 72 patients underwent surgery successfully.None of the children in the small incision group needed to have the incision extended.In small-incision and tradition groups,the length of the incision was(2.5±0.3)cm and(4.8±1.9)cm respectively,and the length of stay was(4.4±1.8)days and(6.7±2.6)days respectively.Both differences were statistically significant(P<0.01).In traditional group,5 cases(12.8%)had surgery-related complications including 2 cases of wound infection,1 case of cerebrospinal fluid leakage and 2 cases of pain requiring medication.Only 1 case of pain(3.0%,1/33)required medication in small-incision group.The effective rates in traditional and small-incision groups were 92.3%(36/39)and 93.9%(31/33)respectively at 6 months post surgery,and the difference was not statistically significant(P>0.05).At the end of follow-up,the total effective rate in traditional group(>6-41 months)was 89.7%(35/39),while that in small-incision group(>6-27 months)was 93.9%(31/33).There was no statistically difference between them(P>0.05).Conclusion The small-incision untethering for children with TCS who need merely transection of terminal filament seems as effective as traditional large-incision surgery.It has the advantages of small trauma and short length of stay.