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目的通过对611例脂肪瘤型脊髓拴系综合征临床数据分析,比较儿童与成人脂肪瘤型脊髓拴系综合征的显微外科治疗疗效。方法清华大学玉泉医院自2004年1月~2010年1月收治并有效随访的脂肪瘤型脊髓拴系611例,分为儿童组和成人组,患者术前均行神经系统、MRI、残余尿及神经电生理检查,术中在电生理监测下行显微外科手术治疗。疗效评估分为近期疗效和远期疗效,近期疗效根据Hoffman功能性分级、Kirollos术中松解分级和并发症评估;远期疗效根据临床表现、MRI、膀胱残余尿和神经电生理结果进行评估。根据这些指标比较儿童组与成人组间的疗效差异。统计学通过SPSS16.0分析处理数据。结果近期随访:根据Hoffman功能性分级:术后改善的患者在儿童组和成人组间有明显差异(P<0.05),术后稳定的患者在在儿童组和成人组间无明显差异(P>0.05),术后加重的患者在儿童组和成人组间有明显差异(P<0.05);按Kirollos术中松解分级评定方法:Ⅰ级的患者在儿童组和成人组间有明显差异(P<0.05),Ⅱ级的患者在儿童组和成人组间有明显差异(P<0.05),Ⅲ级的患者在儿童组和成人组间有明显差异(P<0.05);儿童组发生并发症比成人组少。远期随访:膀胱残余尿减少的患者在儿童组和成人组间有显著性差异(P<0.05);MRI检查在儿童组和成人组间均未发现脂肪瘤明显复发病例;神经电生理改善的患者在儿童组和成人组间有显著性差异(P<0.05)。结论儿童脂肪瘤型脊髓拴系综合征的显微治疗比成人可获得更好的疗效。
Objective To analyze the clinical data of 611 cases of liposarcoma tethered syndrome and compare the effect of microsurgery in children and adults with liposarcoma tethered syndrome. Methods 611 cases of lipoma type tethered cord in Yuquan Hospital of Tsinghua University from January 2004 to January 2010 were divided into pediatric group and adult group.The patients underwent MRI, residual urine and Neurophysiological examination, intraoperative electrophysiological monitoring down microsurgery. The curative effect is divided into short-term curative effect and long-term curative effect. The recent curative effect is based on the Hoffman functional classification, Kirollos intraoperative release classification and complication evaluation. The long-term curative effect is evaluated according to clinical manifestations, MRI, bladder residual urine and neuroelectrophysiological results. The differences in efficacy between children and adults were compared on the basis of these indicators. Statistics SPSS16.0 analysis and processing of data. Results Recent follow-up: According to the Hoffman functional classification, patients who improved postoperatively had significant differences between children and adults (P <0.05), patients with postoperative stability had no significant difference between children and adults (P> 0.05). There was a significant difference between the children group and the adult group after operation (P <0.05). According to the method of Kirollos intraoperative release classification, the grade Ⅰ patients had significant difference between the children group and the adult group (P < 0.05). There was a significant difference between children and adults in grade Ⅱ (P <0.05). There was a significant difference in grade Ⅲ between children and adults (P <0.05). Complications in children were higher than those in adults Group less. Long-term follow-up: There was a significant difference between children and adults in bladder residual urine (P <0.05); MRI showed no significant recurrence of lipoma between children and adults; and neuroelectrophysiological improvement There was a significant difference between children and adults (P <0.05). Conclusion Microsurgery of pediatric lipoma tethered syndrome may achieve better therapeutic effect than that of adults.