经小切口单侧椎间隙入路手术治疗圆锥位置正常与圆锥低位儿童终丝型脊髓拴系综合征的疗效对比

Efficacy comparison of unilateral intervertebral approach through small incision for the treatment of filamentous tether syndrome in children with normal conus position versus low conus position

目的对比分析经小切口单侧椎间隙入路手术治疗儿童圆锥位置正常与圆锥低位终丝型脊髓拴系综合征的疗效。方法回顾性分析2017年4月至2020年10月在湖南省儿童医院行终丝离断术治疗的56例终丝型脊髓拴系综合征患儿临床资料。根据圆锥位置,将患儿分成圆锥位置正常组(40例)和圆锥位置下移组(16例)。对比两组患儿的临床症状、影像学资料、术后疗效等。结果所有患儿顺利完成手术。圆锥位置正常组中,小便功能障碍改善19例(尿失禁改善4例,尿频改善4例,遗尿改善11例),大便功能障碍改善18例(便秘改善12例,粪污改善6例),腰痛缓解1例,下肢麻木缓解4例。圆锥低位组中,小便功能改善7例(尿失禁改善1例,尿频改善2例,遗尿改善4例),大便功能改善6例(便秘改善4例,粪污改善2例),腰痛缓解1例,下肢麻木缓解1例。两组小便功能功能障碍、大便功能障碍、腰痛或下肢麻木改善率差异无统计学意义(P>0.05)。圆锥位置正常组中,膀胱残余尿量较术前改善17例,肛门直肠测压反应改善17例,双下肢体感诱发电位较术前改善4例。圆锥低位组中,膀胱残余尿量较术前减少6例,肛门直肠测压反应改善5例,双下肢体感诱发电位较术前改善1例。两组患儿在膀胱残余尿量、肛门直肠测压及双下肢体感诱发电位改善率方面比较,差异均无统计学意义(P>0.05)。结论终丝型脊髓拴系综合征患儿圆锥位置与其神经功能损伤程度及术后恢复情况无关。但本研究纳入的病例数较少,需收集更多病例进一步验证。

Objective To compare the difference of postoperative efficacy between children with normal conus position and those with reduced conus position in tethered cord syndrome.Methods From April 2017 to October 2020,retrospective analysis of clinical data was performed for 56 cases of filum terminale in tethered spinal cord.Clinical symptoms,imaging data and postoperative outcomes were recorded.All operations were successful without obvious postoperative complications.χ2 test revealed a significant inter-group difference in clinical manifestations of sacral tail skin lesions(χ2=6.890,P=0.009).No difference existed in clinical manifestations of defecation,urination dysfunction,lumbago or lower limb sensory/motor abnormalities and the difference was not statistically significant.Comparative analysis of auxiliary examination.Results Indicated that no significant inter-group differences existed in terminus tension,bladder residual urine volume,anorectal manometry or bilateral lower extremity sensory evoked potential.No significant inter-group difference existed in postoperative efficacy.A comparative analysis of postoperative auxiliary examination revealed that no significant abnormalities existed in improvement rate of bladder residual urine volume,anorectal pressure measurement or bilateral extremity sensory evoked potential between two groups.There was no statistical significance.Conclusion Cone position in children with tether syndrome has no relationship with the severity of neurological impairment and postoperative recovery.However,the number of cases is small in this group.And more cases are required for further verifications.