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目的探讨背部中线皮肤局部表现及其在神经管缺陷(NTD)早期诊断中的意义。方法对河北省儿童医院神经外科2009年7月至2012年12月收治的172例NTD患儿初次就诊年龄、初次磁共振成像(MRI)年龄、手术年龄及皮肤局部表现类型等数据进行回顾性分析。根据患儿皮肤局部表现分为明显类和非明显类。结果172例NTD患儿中脂肪瘤型最多,为41例(23.8%),其次依次为脊髓脊膜膨出型39例(22.7%)、脊膜膨出型27例(15.7%)、皮肤异常27例(15.7%)、藏毛窦13例(7.6%)、无标记8例(4.7%)、皮坠或小丘5例(2.9%)、多毛5例(2.9%)、血管瘤4例(2.3%)、小凹3例(1.7%)。皮肤局部表现明显类66例(38.4%)、非明显类106例(61.6%)。非明显类早期就诊率(63.2%,67/106)、早期诊断率(41.5%,44/106)、早期手术率(37.7%,40/106)均小于明显类[90.9%(60/66),81.8%(54/66),69.7%(46/66)],差异均有统计学意义(P均<0.05)。皮肤局部表现仅是神经受损的提示,而不能提示神经受损或持续受损严重程度。结论提高对NTD表面标记的认知,尤其是对非明显类NTD表面标记的认知,是提高NTD早期诊断简便有效的方法。
Objective To investigate the local manifestations of midline dorsal skin and its significance in the early diagnosis of neural tube defects (NTD). Methods Retrospective analysis was performed on the data of 172 patients with NTD who were admitted to Department of Neurosurgery, Children’s Hospital of Hebei Province from July 2009 to December 2012, including the age at first visit, the age of first MRI, the age of surgery and the type of local skin manifestations . According to the local performance of children’s skin is divided into obvious and non-obvious class. Results The majority of lipoma in 172 cases of NTD were found in 41 cases (23.8%), followed by myelodysplasia in 39 cases (22.7%), meningocele in 27 cases (15.7%), skin abnormalities 27 cases (15.7%), 13 cases of Tibetan sinus (7.6%), 8 cases (4.7%) without marking, 5 cases (2.9%) of skin or hillocks, 5 cases of hirsutism (2.9%), 4 cases of hemangiomas (2.3%), small concave in 3 cases (1.7%). 66 cases (38.4%) showed obvious local skin lesions and 106 (61.6%) non-obvious ones. The early diagnosis rate of non-obvious type was 63.2%, 67/106, the early diagnosis rate was 41.5% and the rate of early operation was 37.7% and 40/106 respectively, which was lower than that of obvious type [90.9% (60/66) , 81.8% (54/66) and 69.7% (46/66), respectively. The differences were statistically significant (all P <0.05). Local skin performance is only a sign of nerve damage, but can not prompt nerve damage or sustained damage severity. Conclusion Increasing the cognition of NTD surface markers, especially the cognition of non-obvious NTD surface markers, is a simple and effective method to improve the early diagnosis of NTD.