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目的探讨小儿脂肪瘤型脊髓栓系综合征的临床分型及手术干预方式,并进行术前术后神经功能评估。方法回顾性分析自1995年5月至2010年5月我们收治的900例脂肪瘤型脊髓栓系综合征患儿临床资料,根据术中所见及术前MRI归纳出5种类型:Ⅰ型为脂肪脊髓脊膜膨出型;Ⅱ型为硬膜外型;Ⅲ型含硬膜内、外型;Ⅳ型为硬膜内型;Ⅴ型为终丝型。术中采取脂肪瘤切除、终丝切断等方式干预。采用Hoffman功能评分标准评估手术疗效。结果900例均获随访,随访时间3年以上,治疗有效率:Ⅰ型为65%(130/200),Ⅱ型为100%(100/100),Ⅲ型为70%(210/300),Ⅳ型为75%(150/200),Ⅴ型为100%(100/100)。总有效率为82%。结论对脂肪瘤型脊髓栓系综合征进行合理临床分型、选择合适的手术方式及进行准确的神经功能评估,可提高脂肪瘤型TCS的治疗效果。
Objective To investigate the clinical classification and surgical intervention of pediatric lipoma type tethered cord syndrome and evaluate the neurological function before and after operation. Methods The clinical data of 900 patients with lipoma type tethered cord syndrome admitted to our hospital from May 1995 to May 2010 were retrospectively analyzed. According to the intraoperative findings and preoperative MRI, 5 types were summarized: type Ⅰ was Fat spine meningocele; Ⅱ type of epidural; Ⅲ with intradural, appearance; Ⅳ type of intradural; Ⅴ type of the terminal filament. Surgery to take lipoma resection, the end of the wire cut off and other interventions. The Hoffman function score was used to evaluate the curative effect. Results All 900 patients were followed up for more than 3 years. The effective rate was 65% (130/200) for type Ⅰ, 100% (100/100) for type Ⅱ, 70% (210/300) for type Ⅲ, Type IV was 75% (150/200) and Type V was 100% (100/100). The total effective rate was 82%. Conclusion Reasonable clinical classification of lipoma type tethered cord syndrome, select the appropriate surgical methods and accurate assessment of neurological function, can improve the treatment of lipoma TCS.