超声在脊髓栓系患儿诊断及随访中的应用

Application of Ultrasound in Diagnosis and Follow-up of Children with Tethered Spinal Cord

目的探讨超声在脊髓栓系患儿诊断及随访中的应用及其优势.方法通过回顾2017年4月至今72例脊髓栓系综合征(tethered cord syndrome,TCS)患儿的超声表现,并与MRI图像及手术结果进行对比分析.结果72例脊髓栓系患儿中脊髓脊膜膨出伴脂肪瘤39例(54%),脊膜膨出伴脂肪瘤24例(34%),皮毛窦伴脂肪瘤7例(10%),囊肿2例(3%),其诊断结果均与手术结果一致;72例患儿中7例(10%)存在椎管扩张,余椎管均正常;中央管存在扩张者17例,其中轻度扩张(<3 mm)11例(65%),中度扩张(3~6 mm)4例(24%),重度扩张(>6 mm)2例(12%);62例可追踪到MRI的病例中,42例(68%)脊髓圆锥终止位置与MRI相同,18例(29%)脊髓圆锥终止位置低于MRI一个椎体水平,2例(3%)脊髓圆锥终止位置高于MRI一个椎体水平;72例患儿中脊髓圆锥摆动不明显者(≤0.3 mm)12例(17%),脊髓圆锥摆动幅度减弱者(0.3~0.7 mm)49例(68%),脊髓圆锥摆动幅度尚正常者(>0.7 mm)11例(15%);术后随访中,15例仅终丝受牵拉者术后脊髓圆锥摆动幅度均明显增加;36例脂肪切除者,髓囊比≤30%者27例,30%~50%者8例,≥50%者1例,其结果与MRI结果相同.结论超声检查在脊髓栓系患儿病因诊断、椎管及脊髓宽度、脊髓圆锥形态及术后随访等方面同MRI检查无差异;在脊髓圆锥末端定位、动态观察脊髓圆锥摆动幅度方面优于MRI表现;超声检查作为一种无创、简便、可重复性较强的检查手段,在脊髓栓系疾病诊断及随访中具有重要价值.

Objective To investigate the application and advantages of ultrasound in the diagnosis and follow-up of infants with tethered cord.Methods By reviewing the ultrasound findings of 72 children with tethered cord disease from April 2017 to the present,we compared MRI images with surgical results.Results Among the 72 cases of tethered cord syndrome(TCS),39 cases of spinal meningocele with lipoma(54%),24 cases of meningocele with lipoma(34%),7 cases of fur sinus with lipoma(10%),2 cases of cyst(3%).The diagnosis results are consistent with the surgical results.Among the 72 cases of TCS,7 cases of spinal canal dilatation,the remaining spinal canal is normal.There are 17 cases of expansion in the central tube,mild expansion(<3 mm)in 11 cases(65%),moderate expansion(3-6 mm)in 4 cases(24%),severe expansion(>6 mm)in 2 cases(12%).Among 62 cases traceable to MRI,42 cases(68%)of spinal conus termination position were the same as MRI,18 cases(29%)of spinal cone termination position is lower than MRI one vertebral level,2 cases(3%)of spinal conus termination position is higher than MRI one vertebral level.Among the 72 cases of TCS,12 cases(17%)of spinal conic swing are not obvious(≤0.3 mm),49 cases(68%)of spinal conical swing amplitude reduction(0.3-0.7 mm),11 cases(15%)of spinal cone swing amplitude is still normal(>0.7 mm).During postoperative follow-up,the amplitude of the spinal cone swing increased significantly in 15 cases with only the lilum terminate pulled.There are 36 cases after lipoma excision,27 cases of cord sac≤30%,8 cases of cord sac between 30%-50%,1 case of cord sac≥50%.Conclusion Ultrasound examination show no difference from MRI in diagnosis of the cause,the width of spinal canal and spinal cord,spinal cord cone shape and the sacral plate.It is superior to MRI in the positioning of the conus end of the spinal cord and dynamic observation of the swing amplitude of the spinal cord.As a non-invasive,simple and reproducible examination method,ultrasonography has a great value in the diagnosis and follow-up of tethered cord disease.