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目的评价Ⅰ型和Ⅱ型儿童脊髓纵裂的显微外科手术疗效。方法清华大学玉泉医院自2004年1月至2011年1月收治并有效随访的191例脊髓纵裂患儿纳入本研究。根据Pang分型标准分为Ⅰ型(75例)和Ⅱ型(116例),术前均行神经系统检查、膀胱残余尿、神经电生理检查、MRI检查以及CT检查,术中在电生理监测下行显微外科手术治疗。手术后进行神经系统检查、尿动力学、神经电生理及MRI等检查。根据临床症状、膀胱残余尿、MRI检查和神经电生理等结果对比评定Ⅰ型和Ⅱ型的疗效。结果Ⅰ型组75例患儿中,术后疗效优(痊愈)1例,良(显效)30例,可(有效)40例,差(无效)4例,总有效率94.6%。Ⅱ型组116例患儿中,术后疗效优(痊愈)28例,良(显效)49例,可(有效)36例,差(无效)3例,总有效率97.4%。Ⅰ型组和Ⅱ型组膀胱残余尿减少的患者比例差异有统计学意义(57.3%vs.70.7%,P<0.05);MRI检查在Ⅰ型组和Ⅱ型组间均未发现纵裂复发病例;Ⅰ型组和Ⅱ型组神经电生理改善的患者比例的差异有统计学意义(P<0.05)。结论显微外科手术治疗儿童脊髓纵裂可获得较好的疗效,Ⅱ型的疗效优于Ⅰ型。
Objective To evaluate the effect of microsurgery on type I and type II children with longitudinal spinal cord. Methods 191 cases of schizophrenia children admitted to Yuquan Hospital of Tsinghua University from January 2004 to January 2011 were included in this study. According to Pang classification criteria, the patients were divided into type Ⅰ (75 cases) and type Ⅱ (116 cases). Neurological examination, residual bladder urine, neuroelectrophysiology, MRI and CT were performed preoperatively. Electrophysiology monitoring Down microsurgical treatment. After surgery, neurological examination, urodynamic, neurophysiological and MRI examination. According to clinical symptoms, bladder residual urine, MRI examination and neuroelectrophysiology and other results compared to evaluate the type Ⅰ and type Ⅱ curative effect. Results Among the 75 cases of type Ⅰ, there were 1 case of good outcome (cured), 30 cases of good (effective), 40 cases of effective (effective) and 4 cases of poor (ineffective) with a total effective rate of 94.6%. Among 116 cases in type Ⅱ group, there were 28 cases with good curative effect (cured), 49 cases with good (markedly effective), 36 cases with effective (effective) and 3 cases with poor (ineffective) with a total effective rate of 97.4%. There was significant difference in the proportion of residual urinary bladder in type Ⅰ and type Ⅱ patients (57.3% vs. 70.7%, P <0.05). MRI showed no recurrence of longitudinal split between type Ⅰ and type Ⅱ There was significant difference in the proportion of patients with neuro-electrophysiological improvement in type I and type II (P <0.05). Conclusion Microsurgery can treat children with longitudinal spinal cord fractures with good curative effect. Type Ⅱ is better than type Ⅰ.