经单侧椎间隙入路手术治疗儿童终丝型脊髓拴系的疗效分析
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摘要
目的探讨经单侧椎间隙入路手术治疗儿童终丝型脊髓拴系的方法和疗效。方法回顾性分析2015年1月至2018年8月经单侧椎间隙入路手术治疗的32例终丝型脊髓拴系患儿的临床资料。结果所有患儿经单侧椎间隙入路手术离断终丝,拴系完全松解。住院期间2例会阴部和下肢间断疼痛的患儿术后疼痛立即缓解,3例双下肢活动障碍的患儿术后肌力减退未有加重。32例出院后随访2～31个月,无一例出现新发神经系统症状。1例术前有排尿及排便功能障碍者术后无明显改善,其他二便障碍患儿术后排便功能均有所改善; 1例外伤后单侧下肢肌力0级患儿术后6个月肌力恢复至4级,另外2例以肌张力高为表现的双下肢活动障碍患儿在康复治疗后明显改善。结论经单侧椎间隙入路手术治疗终丝型脊髓拴系符合微创外科手术理念,缩短了手术时间,具有出血少、创伤小、并发症少、不损害脊柱稳定性等优点,疗效满意。
Objective To explore the approach and efficacy of accessing unilateral intervertebral space for terminal filum in children with tethered spinal cord( TCS). Methods The clinical data were reviewed for 32 TCS children with terminal filum operated from January 2015 to August 2018. Results All children were operated via unilateral intervertebral space. Terminal filum was successfully dissected and bolt completely released. During hospitalization,2 children with intermittent pain of perineum and lower limbs were relieved immediately post-operation and 3 children with motor disorders of both lower limbs did not aggravate. During a follow-up period of 2-31 months,no new neurological deficit occurred. One case of dysuria and defecation showed no significant postoperative improvement while other children with dysuria improved. In 1 case,muscle strength grade zero recovered to grade IV in unilateral lower extremity at 6 months post-operation while another two cases of high muscle tension in lower extremities improved significantly after rehabilitation. Conclusion Operating through unilateral intervertebral space is both effective and mini-invasive so that it shortens operative duration,reduces hemorrhage,trauma and complications and does not damage spinal stability.
Objective To explore the approach and efficacy of accessing unilateral intervertebral space for terminal filum in children with tethered spinal cord( TCS). Methods The clinical data were reviewed for 32 TCS children with terminal filum operated from January 2015 to August 2018. Results All children were operated via unilateral intervertebral space. Terminal filum was successfully dissected and bolt completely released. During hospitalization,2 children with intermittent pain of perineum and lower limbs were relieved immediately post-operation and 3 children with motor disorders of both lower limbs did not aggravate. During a follow-up period of 2-31 months,no new neurological deficit occurred. One case of dysuria and defecation showed no significant postoperative improvement while other children with dysuria improved. In 1 case,muscle strength grade zero recovered to grade IV in unilateral lower extremity at 6 months post-operation while another two cases of high muscle tension in lower extremities improved significantly after rehabilitation. Conclusion Operating through unilateral intervertebral space is both effective and mini-invasive so that it shortens operative duration,reduces hemorrhage,trauma and complications and does not damage spinal stability.
引文
1 Yamada S,Iaeono RP,Andrade T,et al.Pathophysiology of tethered cord syndrome[J].Neurosurg Clin N Am,1995,6(2):311-323.DOI:10.1016/s1042-3680(18)30465-0.
2 Sharif S,Allcutt D,Marks C,et al.Tethered cord syndrome recent clinical experience[J].Br J Neurosurg,1997,11(1):49-5l.DOI:10.1080/02688699746690.
3 Sun J,Zhang Y,Wang H,et al.Clinical outcomes of primary and revision untethering surgery in patients with tethered cord syndrome and spinal bifida[J].World Neurosurgery,2018,116:e66-e70.DOI:10.1016/J.wnej.2018.03.221.
4王贤书,张晓茹,曹红宾,等.婴儿脊神经管畸形并脊髓拴系手术方案及预后关系的探讨[J].临床小儿外科杂志,2015,14(3):322-325.DOI:10.3969/j.issn.1671-635.2013.03.004.Wang XS,Zhang XR,Cao HB,et al.Infantile lipoma of the tethered cord syndrome:clinical classification,surgical intervention and the evaluation of neural function[J].J Clin Ped Sur,2015,14(3):322-325.DOI:10.3969/j.issn.1671-635.2013.03.004.
5 Pang D.Spilt cord malfomation clinical syndrome.Neurosurgery[J].1992,31(3):481-500.DOI:10.1155/1992/635029.
6 Hüttmann S,Krauss J,Collmann H,et al.Surgical management of tethered spinal cord in adults:report of 54 cases[J].J Neurosurg,2001,95(2 Suppl):173-178.DOI:10.1007/s12178-016-9372-5.
7 Phuong LK,Schoeberl KA,Raffel C.Natural history of tethered cord in patients with meningomyelocele[J].Neurosurgery,2002,50(5):989-995.DOI:10.1097/00006123-200205000-00011.
8 Satar N,Bauer SB,Scott RM,et al.Late effects of early surgery on lipoma and lipomeningocele in children less than 1year old[J].J Urol,1997,157(4):1434-1437.DOI:10.1097/00005392-199704000-00092.
9 Yamada S,Kberium D,Mandyomr GM,et al.Pathophysiology of tethered cord syndrome and other complex factors[J].Neurological Research,2004,26(7):722-726.DOI:10.1179/016164104225018027.
10 Henry K,MARK S,Paul K.Termination of the normal conus medullaris in children:a whole-spine magnetic resonance imaging study[J].Neurosurg Focus,2007,23(2):E7.DOI:10.3171/FOC-07/08/E7.
11 Agarwalla PK,Dunn IF,Scott RM,et al.Tethered cord syndrome[J].Neurosurg Clin N Am,2007,18(3):531-547.
12孙克明,刘福云.脊髓圆锥和终丝结构与TCS相关研究[J].临床小儿外科杂志,2010,9(5):376-378.DOI:10.3969/J.issn.1671-6353.2010.05.022.Sun KM,Liu FY.Relationship of consus medullaris and terminal filum[J].J Clin Ped Sur,2010,9(5):376-378.DOI:10.3969/J.issn.1671-6353.2010.05.022.
13王乐凯,陶本章,杨昌浩,等.小切口微创在儿童脊髓拴系综合征拴系松解中的应用[J].局解手术学杂志,2018,27(1):56-60.DOI:10.11659/jjssx.05E017043.Wang LK,Tao BZ,Yang CH,et al.Small incision surgical treatment for children with tight filum terminale type of tethered cord syndrome[J].J Reg Anat Oper Surg,2018,27(1):56-60.DOI:10.11659/jjssx.05E017043.
14 Yamada S,Won DJ,Pezeshkpour G,et al.Pathophysiology of tethered cord syndrome and similar complex disorders[J].Neurosurgical Focus,2007,23(2):E6.DOI:10.317/FOC-07/08/E6.
15 Nakanishi K,Tanaka N,Kamei N,et al.Use of prone magnetic resonance imagining for detecting the terminal filum in patients with occult tethered cord syndrome[J].J Neurosurg Spine,2013,18(1):76-84.DOI:10.3171/2012.10.SPI NE12321.
2 Sharif S,Allcutt D,Marks C,et al.Tethered cord syndrome recent clinical experience[J].Br J Neurosurg,1997,11(1):49-5l.DOI:10.1080/02688699746690.
3 Sun J,Zhang Y,Wang H,et al.Clinical outcomes of primary and revision untethering surgery in patients with tethered cord syndrome and spinal bifida[J].World Neurosurgery,2018,116:e66-e70.DOI:10.1016/J.wnej.2018.03.221.
4王贤书,张晓茹,曹红宾,等.婴儿脊神经管畸形并脊髓拴系手术方案及预后关系的探讨[J].临床小儿外科杂志,2015,14(3):322-325.DOI:10.3969/j.issn.1671-635.2013.03.004.Wang XS,Zhang XR,Cao HB,et al.Infantile lipoma of the tethered cord syndrome:clinical classification,surgical intervention and the evaluation of neural function[J].J Clin Ped Sur,2015,14(3):322-325.DOI:10.3969/j.issn.1671-635.2013.03.004.
5 Pang D.Spilt cord malfomation clinical syndrome.Neurosurgery[J].1992,31(3):481-500.DOI:10.1155/1992/635029.
6 Hüttmann S,Krauss J,Collmann H,et al.Surgical management of tethered spinal cord in adults:report of 54 cases[J].J Neurosurg,2001,95(2 Suppl):173-178.DOI:10.1007/s12178-016-9372-5.
7 Phuong LK,Schoeberl KA,Raffel C.Natural history of tethered cord in patients with meningomyelocele[J].Neurosurgery,2002,50(5):989-995.DOI:10.1097/00006123-200205000-00011.
8 Satar N,Bauer SB,Scott RM,et al.Late effects of early surgery on lipoma and lipomeningocele in children less than 1year old[J].J Urol,1997,157(4):1434-1437.DOI:10.1097/00005392-199704000-00092.
9 Yamada S,Kberium D,Mandyomr GM,et al.Pathophysiology of tethered cord syndrome and other complex factors[J].Neurological Research,2004,26(7):722-726.DOI:10.1179/016164104225018027.
10 Henry K,MARK S,Paul K.Termination of the normal conus medullaris in children:a whole-spine magnetic resonance imaging study[J].Neurosurg Focus,2007,23(2):E7.DOI:10.3171/FOC-07/08/E7.
11 Agarwalla PK,Dunn IF,Scott RM,et al.Tethered cord syndrome[J].Neurosurg Clin N Am,2007,18(3):531-547.
12孙克明,刘福云.脊髓圆锥和终丝结构与TCS相关研究[J].临床小儿外科杂志,2010,9(5):376-378.DOI:10.3969/J.issn.1671-6353.2010.05.022.Sun KM,Liu FY.Relationship of consus medullaris and terminal filum[J].J Clin Ped Sur,2010,9(5):376-378.DOI:10.3969/J.issn.1671-6353.2010.05.022.
13王乐凯,陶本章,杨昌浩,等.小切口微创在儿童脊髓拴系综合征拴系松解中的应用[J].局解手术学杂志,2018,27(1):56-60.DOI:10.11659/jjssx.05E017043.Wang LK,Tao BZ,Yang CH,et al.Small incision surgical treatment for children with tight filum terminale type of tethered cord syndrome[J].J Reg Anat Oper Surg,2018,27(1):56-60.DOI:10.11659/jjssx.05E017043.
14 Yamada S,Won DJ,Pezeshkpour G,et al.Pathophysiology of tethered cord syndrome and similar complex disorders[J].Neurosurgical Focus,2007,23(2):E6.DOI:10.317/FOC-07/08/E6.
15 Nakanishi K,Tanaka N,Kamei N,et al.Use of prone magnetic resonance imagining for detecting the terminal filum in patients with occult tethered cord syndrome[J].J Neurosurg Spine,2013,18(1):76-84.DOI:10.3171/2012.10.SPI NE12321.
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