论文部分内容阅读
目的:探讨小儿脂肪瘤型脊髓栓系综合征（tethered cord syndrome，TCS）术后远期神经功能随访情况。方法:收集广西医科大学第一附属医院2005年1月至2012年12月收治的141例脂肪瘤型TCS患儿的临床资料，其中男53例，女88例，手术时年龄范围为1个月至11岁11个月。根据患儿术前有无神经损害症状，将所有患儿分为无症状TCS组（无症状组）47例和有症状TCS组（有症状组）94例，两组患儿的手术均由同一主刀医生完成，手术方法均为在硬膜囊内切除脂肪瘤，松解脊髓和神经根的基础上，继续探查硬膜外腔，松解穿出硬膜的神经根，游离骶囊，离断外终丝。对所有患儿进行8年以上的随访，采用Hoffman神经功能分级及疗效判断将术后与术前情况相比较。结果:无症状组的手术时间为（164. 14±25. 32）min；术后出现脑脊液漏2例，皮下积液1例，再栓系2例，需留置导尿管或行间歇性清洁导尿（clean intermittent catheterization，CIC）8例，需借助工具行走或轮椅2例；术后神经功能稳定27例[57. 4%（27/47）]，加重20例[42. 6%（20/47）]，总有效率为57. 4%（27/47）。有症状组的手术时间为（175. 08±30. 61) min，术后出现脑脊液漏3例，皮下积液3例，再栓系5例，需留置导尿管或CIC 29例，需借助工具行走或轮椅11例；术后神经功能显效10例[10. 6%（10/94），有效24例[25. 5%（24/94）]，稳定37例[39. 4%（37/94）]，加重23例[24. 5%（23/94）]，总有效率为75. 5% （71/94）。结论:远期随访对脂肪瘤型TCS患儿术后神经功能恢复评价更客观、真实，无症状脂肪瘤型TCS患儿应早期行预防性手术，避免神经功能障碍，部分患儿术后远期生活质量较差，应重视术后身体和生理的康复治疗。“,”Objective:To explore the long-term follow-ups of neurological function after untethering for lipoma type tethered cord syndrome (TCS) in children.Methods:From January 2005 to December 2012, clinical data were reviewed for 141 children hospitalized with lipomatous TCS. There were 53 boys and 88 girls with an operative age range of 1 to 143 months. According to the presence or absence of preoperative nerve damage symptoms, they were divided into two groups of asymptomatic TCS (n=47) and symptomatic TCS (n=94). All operations were completed by the same surgeon. The surgical goals were to explore epidural space, release perforated nerve roots, liberate sacral sac and transect external filum terminale on the basis of intracapsular lipoma resection and releasing spinal cord and nerve roots. During a follow-up period of over 8 years, Hoffman’s criteria of neurological grade and efficacy were utilized for comparing the postoperative outcomes.Results:Operative duration of asymptomatic group was (164. 14±25. 32) min. The postoperative outcomes included cerebrospinal fluid leakage (n=2) , subcutaneous exudate (n=1) , rethrombosis (n=2) , indwelling catheter or intermittent clean catheterization (CIC, n=8) and walking or wheelchair with the help of tools (n=2) ; there were postoperative neurological stability (n=27, 57. 4%) and aggravation (n=20, 42. 6%) with an overall response rate of 57. 4% (27/47) . Operative duration of symptomatic group was (175. 08± 30. 61) min. The postoperative outcomes included cerebrospinal fluid leakage (n=3) , subcutaneous exudate (n=3) , rethrombosis (n=5) , need for indwelling catheter or CIC (n=29) and need to walk or wheelchair with the help of tools (n=11) ; postoperative neurological function was markedly effective [10. 6% (10/94) ], effective [25. 5% (24/94) ], stable [39. 4% (37/94) ]and aggravated [24. 5% (23/94) ]with an overall response rate of 75. 5% (71/94) .Conclusions:Long-term follow-up is more objective and realistic in evaluating postoperative neurological recovery in children with lipoma TCS. Children with asymptomatic lipoma TCS should be prophylactically untethering to avoid neurological dysfunction. Some children have poor long-term quality-of-life and postoperative physical and physiological rehabilitations should be strengthened.