成人原发性脊髓拴系综合征的分型及显微外科手术治疗  

Classification and microsurgical treatment of primary tethered cord syndrome in adults

作　　者：林国中 谢京城 陈晓东 杨军 LIN Guo-zhong;XIE Jing-cheng;CHEN Xiao-dong;YANG Jun(Department of Neurosurgery,Peking University Third Hospital,Precision Neurosurgery and Tumor Research Center,Peking University Health Science Center,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,北京大学医学部精准神经外科与肿瘤研究中心,北京100191

出　　处：《北京大学学报（医学版）》2023年第4期641-645,共5页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81601200);北京大学临床医学+X青年专项(PKU2020LCXQ004)-中央高校基本科研业务费。

摘　　要：目的:总结成人原发性脊髓拴系综合征(tethered cord syndrome, TCS)的临床特点、分型及手术治疗经验。方法:回顾性分析2007年3月至2019年10月北京大学第三医院手术治疗的171例成人原发性TCS患者的临床资料,男性61例,女性110例,年龄18~65岁,平均年龄(39.02±11.81)岁,主要症状为腰腿痛、双下肢麻木无力和大小便功能障碍。按照临床特点及医学影像学分为5型:终丝牵张型(69例)、脊髓纵裂型(21例)、脊髓脊膜膨出型(20例)、脂肪脊髓脊膜膨出型(36例)、皮窦道型(25例)。对不同类型的TCS采取相应的显微手术治疗,以Kirollos分级评定手术拴系松解程度,以视觉模拟疼痛评分(visual analogue scale, VAS)评估疼痛情况,采用关键肌肉力量0~5级评分评价下肢运动功能,用日本骨科协会(Japanese Orthopaedic Association, JOA)括约肌功能评分评价膀胱功能。结果:171例患者均经显微手术松解粘连,切断终丝,其中61例将伴随病灶也分离切除。脊髓拴系均达到KirollosⅠ级松解,均重建硬膜囊。除5例脑脊液漏切口愈合不良外,其余无手术并发症,经过再次缝合加俯卧位,伤口均愈合。患者术后疼痛缓解或消失,双下肢无力和大小便功能障碍症状也逐渐恢复。随访时间6个月至12.5年,平均(5.62±2.31)年,153例患者的脊髓功能状态好转,18例稳定,无恶化病例,随访期间未见再拴系。结论:成人原发性TCS按临床特点及医学影像学分为5种类型,按照分型制定手术策略,手术解除脊髓牵张及压迫,恢复正常的解剖结构,预防再粘连,相应的显微手术治疗效果满意。Objective:To summarize the clinical manifestation,classification,and experience of surgical treatment of primary tethered cord syndrome(TCS)in adults.Methods:The authors retrospectively analyzed a series of 171 adult patients with primary TCS who were surgically treated under microscope from March 2007 to October 2019.There were 61 males and 110 females whose ages were 18-65 years,with an average age of(39.02±11.81)years.Clinically,the patients presented with various neurological symptoms and signs including lower back and legs pain,reflex changes,sensory disturbances,muscle weakness,and sphincter problems.They were divided into 5 types by clinical manifestations and neuro-imaging features:(1)filum terminale traction in 69 cases,(2)split cord malformation in 21 cases,(3)myelomeningocele in 20 cases,(4)lipomyelomeningocele in 36 cases,and(5)dermal sinus traction in 25 cases.All the patients underwent microsurgery to untether the spinal cord.The patients kept prone position 7 days postoperatively.The Kirollos grading was used to evaluate the outcome of intraoperative untethering.The visual analogue scale(VAS)was used to evaluate the pain,the score of critical muscle strength was used to evaluate the lower extremity motor function,and the Japanese Orthopaedic Association(JOA)sphincter function score was used to evaluate the bladder function.Results:All of the 171 patients were treated with microsurgery to release the adhesion and cut off the filum terminalis.61 cases of them received resection of the lesions according to the etiology.All the tethered spinal cord reached Kirollos gradeⅠuntethering and the dural sac was reconstructed.Other than 5 patients had cerebrospinal fluid leakage and incision laceration and underwent re-suture,there was no surgical complication.The local pain was relieved,the lower limbs weakness or bowel and bladder dysfunction gradually recovered postoperatively.The period of follow-up ranged from 6 months to 12.5 years with an average of(5.62±2.31)years.The neurological function was impr

关 键 词：脊髓拴系综合征 终丝 脊柱裂 显微外科手术 

分 类 号：R651.2[医药卫生—外科学]