儿童脊髓拴系综合征手术时机的探讨  

Investigation of the operation time in children with tethered cord syndrome

作　　者：刘剑钢[1] 刘瑜[1] 钱虎飞[1] 魏嘉[1] 陈若平[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院神经外科,200062

出　　处：《中华神经外科杂志》2016年第11期1135-1138,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童脊髓拴系综合征的手术时机，寻找脊髓拴系综合征中预防性手术的询证医学证据。方法回顾性分析上海交通大学附属儿童医院神经外科2011年1月至2013年12月收治的145例脊髓拴系综合征患儿的临床资料，就诊时年龄为1d至13岁，平均年龄为（38．6±3．4）个月；其中男93例，女52例，随访时间为24个月。术前按局灶症状、膀胱和（或）直肠症状、运动功能损害症状和其他症状4大类分别记录。术后采用问卷调查的方法进行随访，术后1、3、6、9、12个月和24个月均来院进行问卷调查。按术前、术后的症状是否得到改善分为优秀（术后无症状）、改善、无改善和加重（恶化或添加新症状）4大类分别记录。结果术前症状中有局灶症状者73例（50．3％），有膀胱和（或）直肠症状者41例（28．3％），有运动功能损害症状者21例（14．5％），有其他症状者10例（6．9％）。术后随访中优秀占59．3％（86／145）、改善占24．1％（35／145）、无改善占9．7％（14／145）、术后加重占6．9％（10／145）。统计学分析显示术前有局灶症状者的术后优秀率显著高于术前有症状者（97．3％比20．9％，P〈0．05）。结论脊髓拴系综合征患儿应在出现神经系统损害症状时接受手术，建议在24个月前完成手术。鉴于预防性手术的安全．1生高、效果优异，值得尝试。Objectives To investigate the operation time in children with tethered cord syndrome and to search for the evidence of the evidence-based medicine of prophylactic surgery in tethered cord syndrome. Methods The clinical data of 145 children with tethered cord syndrome admitted to the Department of Neurosurgery, Shanghai Children＇s Hospital, Shanghai Jiao Tong University from January 2011 to December 2013 were analyzed retrospectively. The age at presentation was 1 day to 13 years （ mean 38.6±3.4 months ） , 93 of them were males and 52 were females. The follow-up time was 24 months. Their preoperative symptoms were documented according to 4 categories： focal symptoms, bladder and/or rectal symptoms, symptoms of motor function impairment, and other symptoms. The follow-up was conducted by means of questionnaire survey after procedure. At 1, 3, 6, 9, 12, and 24 months after procedure, they came to hospital and a questionnaire survey was conducted by the follow-up specialists. They were documented and divided into excellent （no postoperative symptoms） , improvement, no improvement, and aggravation （worse or having new symptoms ）, respectively according to whether their preoperative and postoperative symptoms were improved or not. Results In the preoperative symptoms, 73 patients （50. 3% ） had focal symptoms, 41 （28.3%） had bladder and/or rectal symptoms, 21 （ 14.5% ） had motor function impairments, and 10 （6.7%） had other symptoms. During the follow-up after procedure, 59.3% （86/145） were excellent, 24.1% （35/145） were effective, 9.7% （14/145） were ineffective, and 6. 9% （10/145） were aggravated. The statistical analysis showed that in children with focal symptoms before operation, the postoperative excellent rate was significantly higher than the children having symptoms before procedure （97.3% vs. 20.9% ; P 〈 0.05）. Conclusions Children with tethered cord syndrome should be treated surgically in the presence of the symptoms of nervous system damage. It is recomm

关 键 词：脊髓拴系综合征 神经外科手术 手术时机 随访 儿童 

分 类 号：R726.5[医药卫生—儿科]