复杂型脊髓拴系综合征患者的诊治策略  

Diagnosis and treatment strategies for patients with complicated tethered cord syndrome

作　　者：林和璞[1] 修波[1] 李萃萃 苏辉[1] 张鹏飞[1] 徐如祥[1] LIN He-pu;XIU Bo;LI Cui-cui(Department of Neurosurgery,the First and Seventh Medical Center of Chinese PLA General Hospital,Beijing 100083,China)

机构地区：[1]解放军总医院神经外科医学部,解放军总医院第七医学中心神经外科,北京100083

出　　处：《临床神经外科杂志》2022年第2期182-186,共5页Journal of Clinical Neurosurgery

基　　金：全军“十三五”军事医学创新工程项目(16CXZ001)。

摘　　要：目的研究复杂型脊髓拴系综合征患者的临床症状、影像学表现、治疗策略等。方法回顾性分析89例复杂型脊髓拴系综合征患者的临床资料,通过分析造成脊髓拴系的原因,采取不同的手术策略,达到完全松解脊髓拴系的目的,从而探索复杂型脊髓拴系综合征的个体化诊治策略。结果复杂型脊髓拴系综合征中造成脊髓拴系的主要原因包括终丝病理性增粗及脂肪瘤化、蛛网膜粘连包裹、脊髓脊膜膨出(脊膜膨出)、脊髓末端脂肪瘤、脊椎畸形卡压、脊髓纵裂等。复杂型脊髓拴系综合征通常是由三种及三种以上的致栓因素导致,不同患者表现复杂多变,需采取个体化治疗策略。结论复杂型脊髓拴系综合征通常由三种或三种以上致栓因素导致。针对不同的患者采取个体化手术治疗策略,最终才能达到脊髓拴系彻底松解的目的,这才是个体化治疗的意义。Objective To study the clinical symptoms,imaging manifestations and treatment strategies of patients with complex tethered cord syndrome.Methods The clinical data of 89 patients with complex tethered spinal cord syndrome were analyzed retrospectively.By analyzing the causes of tethered spinal cord,different surgical strategies were adopted to completely release the tethered spinal cord,so as to explore the individualized diagnosis and treatment strategy of complex tethered spinal cord syndrome.Results The main causes of complex tethered cord syndrome included pathological thickening and lipomatosis of terminal filaments,arachnoid adhesion,spinal meningeal bulging(meningocele),terminal spinal lipomas,spinal deformity compression,spinal cord split,etc.Complex tethered cord syndrome was usually caused by there or more tetherized factors.Different patients had complex and variable performances,and individual treatment strategies were required.Conclusions Complex tethered cord syndrome is usually caused by three or more tethering factors.Individualized surgical treatment strategies for different patients can finally achieve the purpose of complete release of spinal cord tether,which is the significance of individualized treatment.

关 键 词：复杂型脊髓拴系综合征 个体化治疗 致栓因素 

分 类 号：R651.2[医药卫生—外科学]