终丝离断术治疗隐性脊髓栓系综合征中短期疗效分析

Analysis of short/medium-term efficacy of filum terminalectomy for occult tethered cord syndrome

目的 回顾性分析隐性脊髓栓系综合征(occult tethered cord syndrome,OTCS)患儿行终丝离断术手术前后临床症状改善情况,为OTCS的诊疗提供参考依据。方法 回顾性分析2007年5月至2016年9月在郑州大学第三附属医院河南省妇幼保健院就诊并行手术治疗的32例OTCS患儿的临床资料,其中男20例,女12例,年龄为(6.8±1.6)岁,术后随访时间为(6.52±1.23)年。32例中4例骶尾部皮坑,2例大便失禁,4例便秘,大便2~4 d/次;6例小便失禁,14例尿频、尿急;19例下肢肌力异常。所有患儿术前、术后均行腰骶部磁共振成像检查、尿常规、尿流动力学及泌尿系统超声检查,通过测定膀胱容量、最大逼尿肌收缩压力、膀胱顺应性及膀胱残余尿量等指标评估患儿术后的改善情况;术前及末次随访时均行腰椎日本骨科协会评估治疗评分(Japanese Orthopaedic Association scores,JOA评分),计算其改善率及改善指数。结果 术后1例大便失禁恢复,2例大便恢复至1 d/次;5例小便失禁改善,11例尿频尿急改善,5例下肢肌力增强;术后14例膀胱残余尿量减少;膀胱容量为(116.1±46.8)ml,平均预期改善76.4%,P=0.017;最大逼尿肌收缩压力为(44.0±13.2)cmH2O(1 cmH2O=0.098 kPa),平均预期改善10%,P=0.001;膀胱顺应性为(41.5±16.6)ml/cmH2O,平均预期改善27.3%,P=0.01;膀胱残余尿量(3.6±3.2)ml,平均预期改善52%,P=0.01;术后JOA评分均较术前增高,21例患儿改善率>25%,改善指数为(2.24±1.42)。结论 终丝离断术可改善OTCS患儿的临床症状,疑似OTCS的患儿应完善相关检查,明确诊断可行手术治疗。

Objective To retrospectively analyze the improvement of clinical symptoms in patients with occult tethered cord syndrome(OTCS)before and after operation and provide evidence for diagnosing and treating OTCS.Methods Retrospective analysis was conducted for clinical data of 32 OTCS children from May 2007 to September 2016.There were 20 boys and 12 girls with an average age of(6.8±1.6)years and the average follow-up period was(6.52±1.23)years.The symptoms included sacral crater(n=4),fecal incontinence(n=2),constipation(n=4),urinary incontinence(n=6),urinary urgency(n=14)and lower limb muscle weakness(n=19).All of them were examined pre/postoperatively by lumbosacral magnetic resonance imaging(MRI),urinary routine,urodynamics and urinary ultrasound.Postoperative outcomes were evaluated by measuring bladder volume,maximal detrusor contractile pressure,bladder compliance and bladder residual urine volume.Lumbar Japanese Orthopedic Association(JOA)score was assessed before and after the last follow-up and improvement/index was calculated.Results Postoperative fecal incontinence was recovered(n=1,17.7%),constipation was recovered to once daily(n=2,33.2%),urinary incontinence was improved(n=5,31.2%),urinary urgency was improved(n=11,68.8%)and muscle strength of lower extremities was increased(n=5,26.3%).Bladder residual urine volume was decreased in 14 cases,average bladder volume was(116.1±46.8)ml and average expected improvement was 76.4%(P<0.017).The mean value of maximal detrusor contractile pressure was(44.0±13.2)cmH2O,the average expected improvement was 10%(P<0.001);the average bladder compliance was(41.5±16.6)ml/cmH2O and the average expected improvement was 27.3%(P<0.01);the average residual urine volume of bladder was 3.6 ml and the average expected improvement was 52%(P<0.01).The postoperative JOA score was higher than that was pre-operation,the improvement rate of 21 patients was>25%and improvement index was(2.24±1.42).Conclusions Filum terminalectomy improves the clinical symptoms of OTCS patients.Surgery may be selected after a definite diagnosis of OTCS.However,long-term efficacies should be further observed.