儿童脊髓纵裂Ⅰ型与 Ⅱ型的疗效对比分析  

The comparative analysis of curative effect of typeⅠand typeⅡdiastematomyelia in children

作　　者：张晓丽[1] 孙振兴[2,3] 萧凯[2,3] 宋亚玲[2,3] 周荣凇[2,3] 崔志强[2,3] 

机构地区：[1]北京大学首钢医院儿科,北京100144 [2]清华大学玉泉医院脊髓脊柱外科 [3]清华大学医学中心

出　　处：《北京医学》2015年第6期540-543,F0002,共5页Beijing Medical Journal

摘　　要：目的评价Ⅰ型和Ⅱ型儿童脊髓纵裂的显微外科手术疗效。方法清华大学玉泉医院自2004年1月至2011年1月收治并有效随访的191例脊髓纵裂患儿纳入本研究。根据Pang分型标准分为Ⅰ型(75例)和Ⅱ型(116例),术前均行神经系统检查、膀胱残余尿、神经电生理检查、MRI检查以及CT检查,术中在电生理监测下行显微外科手术治疗。手术后进行神经系统检查、尿动力学、神经电生理及MRI等检查。根据临床症状、膀胱残余尿、MRI检查和神经电生理等结果对比评定Ⅰ型和Ⅱ型的疗效。结果Ⅰ型组75例患儿中,术后疗效优(痊愈)1例,良(显效)30例,可(有效)40例,差(无效)4例,总有效率94.6%。Ⅱ型组116例患儿中,术后疗效优(痊愈)28例,良(显效)49例,可(有效)36例,差(无效)3例,总有效率97.4%。Ⅰ型组和Ⅱ型组膀胱残余尿减少的患者比例差异有统计学意义(57.3%vs.70.7%,P<0.05);MRI检查在Ⅰ型组和Ⅱ型组间均未发现纵裂复发病例;Ⅰ型组和Ⅱ型组神经电生理改善的患者比例的差异有统计学意义(P<0.05)。结论显微外科手术治疗儿童脊髓纵裂可获得较好的疗效,Ⅱ型的疗效优于Ⅰ型。Objective To compare the therapeutic effect of microsurgery treatment between type I and type II diastematomyelia by analyzing the clinical data of 191 children. Methods One hundred and ninety-one cases with diastema- tomyelia were classified into group type I and group type II based on Pang classification standard from January 2004 to January 2011 in Yuquan Hospital of Tsinghua University. Neurological examinations, MRI, three dimensional CT recon- structions, bladder post void residual and electrophysiological examination were conducted preoperatively. The microsurgical treatment with intraoperative electrophysiological monitoring was performed in all the cases. Neurological examination, high speed bone drill and microscope were used during operation. Neurological examinations, MRI, bladder post void residual and electrophysiological examination were also conducted postoperatively. The efficacy after operation was analyzed according to clinical symptoms, bladder post void residual and electrophysiological examination in the patients. Results There were 75 cases in group type I, 116 cases in group type II. According to Cheng-bin grading system, the effects in group type I were assessed as following： recovery in 1 cases, excellent efficacy in 30, effective in 40 and ineffective in 4. The effects in group type II were assessed as following：recovery in 28 cases, excellent efficacy in 49 cases, effective in 36 cases and ineffective in 3 cases. The markedly effective rate was 94.6% in group type I and 97.4% in group type II respectively. There was significant difference in bladder post void residual between group type I and group type II （P 〈 0.05 ）. There was no recurrent case in two groups by MRI during the follow-up period. There was significant difference in electrophysiological examination index between group type I and group type II （P 〈 0.05）. Conclusion The good efficacy could be obtained by the microsurgery surgery in children with diastematomyelia. The efficacy in type lI is better than in t

关 键 词：脊髓纵裂 显微手术 疗效 儿童 

分 类 号：R726.5[医药卫生—儿科]