儿童隐匿性脊髓拴系综合征治疗方案的探讨  

Exploration of treatment of occult tethered cord syndrome in children

作　　者：胡凯强[1] 靳文[1] 刘赵鹤[1] 候亚冰 吕鹏[1] 郭俊秀[1] 薛薇[1] 

机构地区：[1]山西省儿童医院神经外科,太原030013

出　　处：《中华神经外科杂志》2017年第12期1232-1234,共3页Chinese Journal of Neurosurgery

摘　　要：目的 探讨儿童隐匿性脊髓拴系综合征的诊断、治疗方案及预后.方法 回顾性纳入2007年4月至2013年4月山西省儿童医院神经外科手术治疗16例儿童隐匿性脊髓拴系综合征的患儿.分析患儿的临床症状、影像学资料、尿流动力学检查、术后并发症及预后情况.16例患儿中,尿频、尿失禁9例,大便失禁2例,背部中线皮肤异常9例,下肢感觉、运动障碍4例.术前行脊髓磁共振检查显示圆锥位置均正常,但终丝脂肪瘤化.患者均在神经电生理监测下行终丝切断术,采用脊柱裂神经功能量表（SBNS）评估手术疗效.结果 16例患儿术后随访12 ～84个月,平均（42.0＆#177;20.0）个月.无症状或症状好转13例,症状稳定2例,症状继续恶化1例,手术有效率为94％ （15/16）.结论 儿童隐匿性脊髓拴系综合征若诊断明确,建议尽早行手术治疗,患儿一般预后良好.Objective To explore the clinical symptoms,treatment strategies and prognoses of occult tethered cord syndrome （OTCS） in children.Methods Sixteen children with OTCS underwent operations at Neurosurgery Department of Shanxi Children＆#39;s Hospital from April 2007 to April 2013 whose data were retrospectively analyzed.The clinical symptoms,radiological examination,urodynamic test,complications and prognoses of those patients were documented.Among all 16 cases,the clinical symptoms included urinary incontinence （n =9）,bowel incontinence （2）,cutaneous anomaly in the midline of back （9） and low extremity anomaly （4）.The preoperative MRI demonstrated that the conus in all patients was in the normal position with a fatty filum terminal.Microsurgery was conducted for all patients with neuroelectrophysiological monitoring.The efficacy of surgical treatment was evaluated by the spina bifida neurological scale （SBNS）.Results The follow-up of all 16 patients ranged from 12 months to 84 months with an average of 42.0 ＆#177; 20.0 months.Among them,13 had no symptoms or gained improvement of the symptoms,2 showed no further progression of their symptoms,and 1 patient had symptomatic worsening.The effective rate in the 16 patients with OTCS after surgery was 94% （15/16）.Conclusion Early surgical intervention could be suggested for children with established diagnosis of OTCS and the outcomes seem to be favorable.

关 键 词：脊髓拴系综合征 治疗方案 预后 儿童 

分 类 号：R726.5[医药卫生—儿科]