儿童脊髓纵裂畸形225例诊疗分析  

Clinical analysis of 225 cases of split cord malformation in children

作　　者：胡伟明[1] 刘沛[1] 刘福云[1] 刘军伟 赵裕丰 张宇 牛学强[1] 夏冰[1] 李新伟[1] Hu Weiming;Liu Pei;Liu Fuyun;Liu Junwei;Zhao Yufeng;Zhang Yu;Niu Xueqiang;Xia Bing;Li Xinwei(Department of Pediatric Orthopedic, Third Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Chin)

机构地区：[1]郑州大学第三附属医院小儿骨科,450052

出　　处：《中华小儿外科杂志》2018年第3期204-208,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童脊髓纵裂畸形的临床特点、诊断与治疗方法。方法回顾性分析2005年1月至2016年7月郑州大学第三附属医院小儿骨科诊治的225例脊髓纵裂畸形患儿的临床资料。其中，男77例，女148例；年龄3 d～16岁，平均（5.8±3.1）岁；就诊年龄3 d～1个月（含1个月）14例，1个月～1岁（含1岁）65例，1～16岁146例；纵裂部位位于颈段3例，胸段105例，腰段117例，胸段及腰段5例，颈段、胸段及腰段均有纵裂1例。Ⅰ型172例，Ⅱ型47例，复合型6例。比较患儿手术前后双下肢肌力变化，对手术前后膀胱残余尿量、双下肢神经电生理检测结果进行统计学分析。结果本组225例均行脊髓纵裂间隔切除脊髓栓系松解术，同期或分期行脊柱畸形矫正术。随访1～11年，疗效：优（痊愈）47例，良（显效）71例，可（有效）96例，差（无效或加重）11例。所有患儿术后均复查泌尿系统超声并测量膀胱残余尿量，其中Ⅰ型纵裂、Ⅱ型纵裂、复合型纵裂患儿的膀胱残余尿量分别为（26.7±18.2）ml、（18.2±7.9）ml与（59.9±33.6）ml和术前（59.4±47.2）ml、（46.6±27.3）ml和（103.9±54.6）ml比较，差异均有统计学意义（P均〈0.05）。术后胫后神经电生理检测提示诱发电位波幅（7.23±4.52）mV、神经传导速度（51.34±6.33） m/s及潜伏期电位（3.81±0.59） ms均较术前[（4.71±3.81）mV、（38.59±5.39）m/s和（7.73±0.54）ms]显著改善，差异均有统计学意义（P均〈0.05）。结论脊髓纵裂畸形临床少见，常合并其他神经系统畸形，背部皮肤改变、双下肢发育异常及脊柱畸形有利于早期诊断，显微外科手术对于阻止神经损伤进一步发展、改善已有症状疗效显著。ObjectiveTo explore the clinical characteristics, diagnosis and treatment of split cord malformation （SCM） in children.MethodsFrom January 2005 to July 2016, a consecutive of 225 SCM cases were treated. There were 77 boys and 148 girls with a mean age of （5.8±3.1） years （3 days to 16 years）. The age of treatment was from 3 days to 1 month （n=14）, 1 month to 1 year （n=65） and 1 to 16 years （n=146）. Septums were located at cervical spine （n=3）, thoracic spine （n=105）, lumbar spine （n=117）, both thoracic and lumbar spine （n=5） and from cervical to lumbar spine （n=1）. The Pang＇s types were I （n=172）, II （n=47） and complex （n=6）. Lower limb muscle strength, bladder post-void residual volume and electrophysiological pre and postoperatively were compared.ResultsAll of them underwent spinal cord septum ablation with a simultaneous or staged release of tethered cord deformity. The follow-up period was from 1 to 11 years. The outcomes were cured （n=47）, symptomatic improvements （n=71）, marked symptomatic improvements （n=96） and unchanged （n=11）. All of them received urinary ultrasonography and bladder post-void residual volume after surgery. The mean postoperative volumes of all 3 types were （26.7±18.2）ml, （18.2±7.9）ml and（59.9±33.6）ml versus （59.4±47.2） ml, （46.6±27.3） ml and （103.9±54.6） ml at pre-operation. And the differences were statistically significant （P〈0.05）. After surgery, posterior tibial nerve electrophysiological test was performed. The mean values of evoked potential amplitude, nerve conduction velocity and latent potential were （7.23±4.52） mV, （51.34±6.33） m/s and （3.81±0.59） ms versus （4.71±3.81） mV, （38.59±5.39） m/s and （7.73±0.54） ms at pre-operatively. And the differences were statistically significant（P〈0.05）.ConclusionsThough rare, SCM is frequently associated with other deformities of spinal cord. Skin lesion on back, abnormal development of both lower li

关 键 词：脊髓纵裂 电生理检查 显微外科手术 

分 类 号：R726.8[医药卫生—儿科]