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目的了解圆锥位置正常型脊髓栓系综合征(TCS)患儿的临床表现和诊治特点。方法回顾性分析19例(5～8岁)圆锥位置正常型TCS患儿的临床资料,患儿术前均行放射影像学、尿流动力学、肌电图检查,手术方式采用终丝离断加椎板成形术治疗。术后(7±2)个月复查MRI及尿流动力学,比较患儿手术前后脊髓受牵拉情况及尿流动力学各指标的变化。结果术前MRI显示TCS患儿脊髓圆锥末端位置均在L2椎体下缘以上,终丝呈弓弦样紧张。其中4例显示终丝增粗,3例显示终丝轻度脂肪变;术后显示圆锥位置无明显变化,终丝紧张解除。尿流动力学结果显示术前15例患儿存在逼尿肌过度活动,3例逼尿肌收缩乏力,1例逼尿肌部分收缩功能受损伴膀胱残余尿量增多;术后16例患儿取得较好疗效,余3例下肢情况得到改善,但尿流动力学表现改善不明显。结论圆锥末端位置正常型TCS患儿的诊断需综合考虑其临床表现、放射影像学、肌电图及尿流动力学检查结果,而尿流动力学检查是诊断的关键指标,一经明确诊断,应及早行终丝离断术治疗,椎板成形术可维持患儿脊柱正常结构。
Objective To investigate the clinical manifestations, diagnosis and treatment of children with conformal spinal cord syndrome (TCS). Methods The clinical data of 19 cases (5-8 years old) with conical position normal TCS were analyzed retrospectively. Radiography, urodynamics and electromyography were performed before operation. Treatment of laminoplasty. MRI and urodynamics were reviewed after (7 ± 2) months. The changes of spinal cord traction and urodynamics before and after surgery were compared. Results The preoperative MRI showed that the conus ends of the spinal cord of TCS patients were located above the lower edge of L2 vertebrae. Among them, 4 showed thickening of terminal filaments and 3 showed slight change of fatty end of the terminal filaments. Postoperatively, there was no significant change in conical position, and terminal filaments were relieved. Urodynamics results showed that there were detrusor overactivity in 15 cases preoperatively, detrusor contractility in 3 cases, impaired contractile function in 1 case and increased residual urinary bladder volume in 16 cases. Good curative effect, more than 3 cases of lower extremity conditions have been improved, but no significant improvement in urodynamic performance. Conclusions The diagnosis of TCS patients with conical end position should consider the clinical manifestations, radiographic findings, electromyography and urodynamic findings. Urodynamic examination is the key diagnostic criteria. Once diagnosed, the diagnosis should be performed as early as possible Terminated wire off surgery, laminoplasty to maintain the normal structure of the spine in children.