脊髓纵裂畸形的显微外科治疗  

Microsurgical treatment of split cord malformation

作　　者：罗天宝[1] 尚爱加[2] 崔志强[1] 萧凯[1] 薛超强[1] 宋亚玲[1] Luo Tianbao;Shang Aijia;Cui Zhiqiang;Xiao Kai;Xue Chaoqiang;Song Yaling(Department of Neurosurgery,Tsinghua University YuQuan Hospital,Beijing 100040,China;Department of Neurosurgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]清华大学玉泉医院神经外科,北京100040 [2]解放军总医院第一医学中心神经外科,北京100853

出　　处：《中国微侵袭神经外科杂志》2020年第10期457-460,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都临床特色应用研究课题(编号:Z171100001017140)。

摘　　要：目的探讨脊髓纵裂畸形(split cord malformation,SCM)的临床特征、显微外科策略及疗效。方法回顾性分析37例SCM病例资料,均经显微外科治疗。其中Ⅰ型20例,Ⅱ型17例;儿童16例,成人21例。SCM位于胸腰椎8例,腰椎27例,骶椎2例。32例病人合并脊髓低位和(或)终丝改变。结果Ⅰ型SCM行骨性分隔切除、拴系带松解和硬脊膜重建术19例,终丝切断术18例。Ⅱ型SCM行纤维分隔切除及拴系带松解10例,17例均行终丝切断术。15例有伴发病变者均行一期外科治疗。术后脑脊液漏1例,骶部疼痛2例,双下肢无力恶化1例,假性脊膜膨出1例,切口脂肪液化1例。随访6~24个月,症状稳定13例,好转24例。结论显微外科治疗SCM是一种安全、有效的方法。无论儿童还是成人,Ⅰ型和Ⅱ型SCM均需手术治疗。Objective To investigate the clinical features,microsurgical strategies and therapeutic effects of split cord malformation(SCM).Methods The clinical data of 37 patients with SCM were analyzed retrospectively,all of whom were treated by microsurgery.There were 20 cases of typeⅠSCM and 17 typeⅡSCM,16 patients were children and 21 adults.The SCM was located in the thoracic and lumbar spine in 8 cases,lumbar spine in 27,and sacral spine in 2.There was lower conus and/or terminal filament changes in 32 patients.Results Bony spur removal,fibrous band release and spinal dural reconstruction were performed in 19 cases and filum terminale resection was done in 18 cases for typeⅠSCM.Ten patients had fibrous septum resection and lysis of adhesion bands,and filum terminale resection was done in 17 cases for typeⅡSCM.Fifteen patients with concomitant lesions received one-stage surgical treatment.Postoperative cerebrospinal fluid leakage occurred in 1 case,sacral pain in 2,lower limb weakness deterioration in 1,pseudomeningocele in 1,and incision fat liquefaction in 1.During the follow-up period of 6-24 months,13 patients remained stable and 24 improved.Conclusions Microsurgical treatment of SCM is a safe and effective method.Both type I and type II SCM require surgical treatment for both children and adults.

关 键 词：纵裂畸形 拴系综合征 脊髓 显微外科手术 

分 类 号：R744[医药卫生—神经病学与精神病学] R651.2[医药卫生—临床医学]