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目的探讨影响儿童脊髓栓系综合征(TCS)手术疗效的因素,掌握正确的治疗方法。方法TCS患儿麻醉成功后,取俯卧位沿脊柱后正中切口,切口上界至病变上端正常解剖结构处,下界至栓系终端病变(在骶尾部附着处),打开骨性椎管暴露硬脊膜,脑膜剪剪开硬膜,切除病变,分离出马尾神经,松解脊髓圆锥,再游离终丝。最后完整修补缺损硬脊膜,选择性切断增粗变短的终丝,以达到解除脊髓栓系、降低脊髓张力的目的。结果40例TCS患儿经手术治疗后,治愈24例,排便、排尿等功能恢复正常;好转9例,排尿、排便功能及肢体病变1项明显改善;症状恢复缓慢5例,术后随访期间,排便、排尿等功能恢复与术前症状一致;2例因骶神经发育不全而术后无变化2例,临床症状无明显好转。本组完全松解26例,总有效率为60.71%;部分松解12例,总有效率为31.58%;未松解2例,有效率为0。结论准确的诊断、采取正确的手术方式尽早手术及预防并发症的发生,是治愈儿童TCS的关键。
Objective To explore the factors influencing the curative effect of children’s tethered cord syndrome (TCS) and to master the correct treatment. Methods After successful anesthesia in pediatric patients with TCS, the median incision was made along the posterior column of the prone position, the upper border of the incision was taken to the normal anatomical structure at the upper end of the lesion, the terminal lesion at the lower end of the tethered cord (at the sacrococcygeal tail attachment) Membrane, meningeal scissors to open the dura mater, removal of lesions, separation of the cauda equina nerve, release spinal cord cones, and then the free terminal. Finally complete repair defect dura mater, selectively cut thickening shorter end of the wire, in order to achieve the lifting of the tethered cord, the purpose of reducing spinal cord tension. Results After treatment, 40 cases of TCS were cured and 24 cases were cured. Defecation, urination and other functions returned to normal; 9 cases improved, urination, defecation function and limb lesions were significantly improved; 5 cases were slow to recover symptoms. During the follow-up period, Defecation, urination and other functions recovered consistent with preoperative symptoms; 2 cases of sacral nerve hypoplasia after surgery without change in 2 cases, no significant improvement in clinical symptoms. The group completely loosen 26 cases, the total effective rate was 60.71%; partial loosening in 12 cases, the total effective rate was 31.58%; 2 cases without loosening, the effective rate of 0. Conclusion Accurate diagnosis, take the correct operation as soon as possible surgery and prevention of complications, is the key to cure children with TCS.