脊髓栓系综合征63例分析  

Analysis of 63 cases with tethered cord syndrome

作　　者：徐建民[1] 石晶[1] 唐和虎[1] 周国昌[1] 

机构地区：[1]中国康复研究中心,北京北京博爱医院影像科100077

出　　处：《实用儿科临床杂志》2000年第3期181-182,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的　对脊髓栓系综合征 (TCS)的发病机制、早期诊断和治疗进行讨论。方法　所有病人皆行详细神经系统检查 ,腰骶部摄片和MRI检查 ,按我院 1994年提出的分类方法、MRI影像和术中所见对病变类型进行分类。部分进行肾脏、输尿管及膀胱超声检查。进行统计评价。均经手术治疗 ,予栓系松解 ,术后近期疗效按显效、有效和无效三级评定。结果　 6 3例下肢感觉障碍 36例 ( 5 7% ) ,下肢运动障碍者 19例 ( 30 % ) ,足部畸形者 34例 ( 5 4% ) ,扩约肌功能障碍41例 ( 6 5 % ) ,下肢肌萎缩 19例 ( 30 % )。 9例 ( 14% )肾盂积水。圆锥位置均低于L2 水平。 2 6例 ( 41% )并连续性脊髓纵裂、脊髓空洞、脊髓中央管扩张、Chiari畸形等。本组近期疗效记载者 41例 ,其中显效 16例 ( 39% ) ,有效 19例 ( 46 % )和无效 6例 ( 15 % )。Objective To discuss the etiology, early diagnosis and treatment of TCS by analyzing the clinical data of 63 cases. Method Examinations in nervous system, lumbosacral Xray MRI were conducted, the pathological lesions of TCS observed during operation were classified according to the criteria advocated by our hospital in 1994. Some of these patients also took the supersonic examinations on bladder, ureter and kidney. All the findings of tests were analyzed and evaluated. The surgical release of TCS was performed on all cases and the therapeutic effectiveness within one month after operation was graded according to the physical improvement of the patients: excellent, effective and ineffective. Result Findings of physical examinations were as follows: Impairment of low extremity sensation in 36 cases(57 %), motion disturbance of low extremity in 19 cases(30 %), the sphincter disorder in 41 cases (65.1 %), muscles atrophy of extremity in 19 cases (30 %),deformation of feet in 34 cases (54 %), functional disturbance of sphincter in 41 cases (65 %),myoatrophy of lower extremity in 19 case (30 %),hydronephrosis in 9 cases( 14 %) . All patients associated with low-lying conus and 26 of them complicated with diastematomyelia, syringomyelia ,expansion of myelocoele,and Chia-ri′s deformation. Recent curative effectiveness in 41 patients was recorded, among them 16 cases excellent (39 %), 19 cases improved(46 %) and 6 cases not changed (15 %). Conclusion Surgical release may be the only therapy for TCS.

关 键 词：脊髓栓系综合征 诊断 治疗 

分 类 号：R744[医药卫生—神经病学与精神病学]