髓/囊比值对儿童复杂脊髓脂肪瘤手术后再拴系的影响

Effect of cord/sac ratio on postoperative retethering of complex spinal lipoma in children

目的探讨髓/囊比值对儿童复杂脊髓脂肪瘤手术后远期再拴系的影响。方法回顾性分析2009年1月至2014年6月深圳市儿童医院神经外科采用手术治疗的复杂脊髓脂肪瘤患儿的临床资料,共56例。采用神经电生理监测下显微手术切除脂肪瘤+重塑神经基板+硬膜囊成型的方法。术后应用MRI评估髓/囊比值,分析髓/囊比值对术后远期脊髓再拴系的影响。结果56例患儿均顺利完成手术。术后MRI显示髓/囊比值<30%者10例,30%~50%者31例,>50%者15例。患儿均未发生术后严重并发症。术后中位随访时间为8.9年(5.0~10.5年),失访4例。6例(11.5%,6/52)发生脊髓再拴系需要再次行手术治疗(再拴系组),其中术后髓/囊比值为30%~50%者2例,>50%者4例。无再拴系组的46例患儿髓/囊比值<30%10例,30%~50%27例,>50%9例。两组髓/囊比值差异有统计学意义(P=0.039)。结论髓/囊比值是影响儿童复杂脊髓脂肪瘤术后再拴系的重要因素,髓/囊比值越小,再拴系的概率越小。

Objective To investigate the effect of cord/sac ratio on postoperative long-term retethering of complex spinal lipomas in children.Methods The clinical data of 56 children with complex spinal lipomas treated at Department of Neurosurgery,Shenzhen Children′s Hospital from January 2009 to June 2014 were analyzed retrospectively.The surgical operations of microsurgical resection of lipoma+reconstruction of basal plate+plasty of dural sac under electrophysiological monitoring were performed.The cord/sac ratio was evaluated on postoperative MRI,and the effect of cord/sac ratio on postoperative long-term spinal cord retethering was analyzed.Results All 56 children underwent successful operation.Postoperative MRI indicated that the cord/sac ratio was<30%in 10 cases,30%to 50%in 31 cases,and>50%in 15 cases.No serious postoperative complications occurred.Postoperative follow-up was performed in 52 cases,with a median follow-up period of 8.9 years(5.0 to 10.5 years).There were 6 cases(11.5%,6/52)of spinal cord retethering which required re-operation(retethered group).Among those,the postoperative cord/sac ratio was 30-50%in 2 cases and>50%in 4 cases.In the non-retethering group,the cord/sac ratio was<30%in 10 cases,30-50%in 27 cases,and>50%in 9 cases.There was significant differences in cord/sac ratio between the two groups(P=0.039).Conclusions The cord/sac ratio is the most important prognostic factor affecting the probability of postoperative retethering of complex spinal lipoma.Smaller cord/sac ratio is associated with lower probability of retethering.