脊髓辁系综合征患儿带后切口的观察及护理

脊髓栓系综合征（tethered cord syndrome，TCS）是由于先天或后天原因牵拉圆锥，使圆锥位置下降并产生一系列神经功能障碍和畸形的症候群。一经确诊，行终丝切断和脊髓神经松解手术是治疗儿童TCS的主要手段。但因为此类患儿术前合并症多，脊髓、神经根常有粘连背离且可能合并脂肪瘤等病变，术后易出现切口脑脊液漏、假性脊膜膨出、切口感染、脊髓再栓系等并发症，护理过程复杂。尤其是患儿术后体位不配合、大小便失禁、不能有效地进行功能康复锻炼等因素导致切口愈合过程延长。我科2000年8月-2005年8月共收治10例TCS患儿，通过有效护理，促进了患儿的康复，现报道如下。[第一段]     

婴幼儿脊髓拴系综合征术后并发症的观察和护理

脊髓拴系综合征(tethered cord syndrome,TCS)是指由于先天性及后天性因素如脊髓脂肪瘤、皮样囊肿、脊膜膨出、变短增粗的终丝等导致脊髓末端受压或(和)回缩不良,产生一系列神经功能障碍和畸形的症候群[1]。TCS致残率高,诊断治疗越早疗效越好[2]。我院1999年1月~2006年8月收治86例TCS婴幼儿,术后密切观察和护理并发症,均痊愈出院。现将护理体会报告如下。1临床资料1.1我院1999年1月~2006年8月,共进行脊髓拴系综合征松解手术86例,男性50例,女性36例;年龄2~18个月。临床表现为腰骶部脂肪瘤67例,腰骶部脊膜膨出12例,腰骶部多毛、皮肤小凹窝…     

小儿脊髓栓系综合征围手术期的护理

脊髓栓系综合征(tetheredcordsyndrome,TCS)系由先天性或后天性因素致脊髓圆锥低位,硬膜内终丝缩短增粗、纤维粘连或脂肪团块等病变,使脊髓活动受限,从而引发一系列临床症状,如排尿、排便功能障碍、下肢瘫痪及足部畸形,并呈渐进性恶化[l].TCS强调早发现、早诊断、早手术治疗[2].但手术涉及体位脊髓圆锥和马尾神经,手术操作相对较为复杂.患儿术前多有硬脊膜缺损、且配合性差,导致术后并发症较多,如术后脑脊液漏、伤口愈合困难、泌尿系统感染等.我院2010年11月～2011年6月收治患有脊髓栓系综合征的小儿14例,均取得了良好的治疗和护理效果,现将护理经验报告如下.     

小儿脊髓栓系综合征根治术的护理配合

脊髓栓系综合征(Tethered cord syndrome TCS)是婴幼儿发育时脊髓圆椎在椎管内上升过程中受膨出的脊膜、增粗变短的终丝、纤维粘连等牵拉,受椎管内脂肪瘤、皮样囊肿等压迫所导致的圆锥缺血缺氧而出现大小便失禁、足畸形、双下肢感觉运动功能障碍等一系列神经功能障碍和畸形的一组征侯群.TCS发病率较高,但由于被认识较晚,病人分散到神经外科、泌尿外科、小儿外科及骨科,极易漏诊和误诊.手术是治疗TCS唯一有效的方法,TCS一旦确诊,不论是否有明确的症状,均应早期手术.2008～2010年我院收治此类患儿51例,经显微外科手术松解脊髓圆椎,终丝离断术后效果良好.现将手术配合与体会报告如下.     

脊髓栓系综合征患儿栓系松解手术的护理

报告了对69例脊髓栓系综合征(TCS)患儿脊髓栓系松解手术的护理.术前向家长讲解TCS的知识,认真做好各项术前检查;术后注意保持正确的卧位,密切观察生命体征变化及有无脑脊液漏,认真做好出院指导.     

脂肪瘤型脊髓栓系综合征的影像检查显微外科治疗

脂肪瘤型脊髓栓系综合征是指腰骶部皮下较大的脂肪包块与椎管内相延续,并与脊髓神经及终丝交织生长,限制了脊髓端回缩,特别脊髓是圆椎部位发生缺血性病理改变,引起感觉,运动,膀胱、直肠等神经功能障碍。１　临床资料男１１例,女２３例,１０～１５岁１９例,１６～２０岁８例,２１～２５岁４例,２６～３０岁２例,４２岁１例。下肢运动障碍及马鞍形感觉障碍２４例,尿失禁２１例,尿潴留１１例,排便障碍２１例,足畸形２３例,下肢营养性溃疡９例,肾盂积水１１例,尿毒症６例。全部患者均有腰骶部皮下脂肪包块,皮肤隆起面积最小…     

脊髓栓系综合征患儿栓系松解手术的护理

报告了对69例脊髓栓系综合征(TCS)患儿脊髓栓系松解手术的护理。术前向家长讲解TCS的知识,认真做好各项术前检查;术后注意保持正确的卧位,密切观察生命体征变化及有无脑脊液漏,认真做好出院指导。     

1例椎管内外节细胞神经瘤患儿的护理

目的 探讨椎管内外节细胞神经瘤患儿的护理方法.方法 对椎管内外节细胞神经瘤患儿行肿瘤切除术.术前加强心理护理、安全防护、营养支持及完善术前准备,术后严密观察脊髓功能的恢复情况,积极预防并发症,有效科学的指导患儿的功能锻炼.结果 患儿手术切口愈和良好,未发生切口感染、脊髓功能受损等并发症,治愈出院.结论 术前术后合理有效的护理方法有利于椎管内外节细胞神经瘤患儿的术后恢复及预防并发症.     

腰脊膜膨出术后并发脊髓拴系综合征

目的：探讨腰脊膜膨出术后并发脊髓拴系综合征的原因及治疗方法。方法：9例腰脊膜膨出患者术后均出现腰背、腰骶、鞍区的广泛疼痛；其中4例伴尿失禁，1例双下肢感染运动障碍，2例足内翻畸形；CT与MRI检查显示低位脊髓圆锥、终丝增粗、腰骶脊柱裂；行显微手术松解拴系与硬膜修补；术后肢体屈伸功能训练。结果：随访1－3年，平均1.4年，疼痛显著改善，尿失禁恢复明显，足部畸形无变化。结论：腰骶脊膜膨出多合并脊髓拴系综合征。术前需行CT、MRI检查，手术应严格显微操作，松解拴系，硬膜修补。     

脊髓拴系综合征伴隐性脊柱1例

患者女,13岁,主因骶尾部多毛6年,右下肢无力进行性加重2年于2007年12月22日入院.腰椎平片显示:腰骶部椎板缺如,腰椎左侧弯;腰椎MRI显示:终丝增粗,在L4,5处和背侧硬脊膜粘连.人院诊断:脊髓拴系综合征(TCS)伴隐性脊柱裂.于2007年12月26日全麻下行脊髓拴系终丝切断+粘连松解术.     

Tethered cord syndrome: a pediatric case study

Tethered cord syndrome, seen in patients with spinal dysraphism, is a progressive neurological deterioration due to stretching of the spinal cord. Spinal dysraphism results from defects during embryonic closure of the neural tube, usually in the lumbosacral region. In tethered cord syndrome an abnormally low conus medullaris is tethered by intradural abnormalities such as a short, thickened filum terminale, fibrous bands, a lipoma or diastematomyelia. This article distinguishes tethered cord syndrome from other forms of occult spinal dysraphism and describes and compares normal anatomy to pathological changes. Clinical symptoms and nursing management of the pediatric patient with tethered cord syndrome will be exemplified by a case study presentation.     

脂肪瘤型脊髓栓系综合征MRI分型与临床表现的相关研究

目的探讨MRI对脊髓栓系综合征(TCS)合并脂肪瘤患者脂肪瘤内神经纤维的显示及MRI分型与临床表现相关性研究。方法回顾性分析23例MRI诊断为脊髓栓系合并脂肪瘤患者脂肪瘤内神经纤维的MRI图像与临床表现。结果本组共23例TCS合并脂肪瘤患者MRI均可以明确神经纤维位置、走行及毗邻关系等解剖学特征。MRI简单型共7例,包括单纯脂肪瘤1例、粘连型6例;MRI复杂型共16例,包括包绕型4例,包绕并融合型12例。MRI显示复杂型TCS合并脂肪瘤患者较简单型患者更易出现明显临床症状(P=0.007)。结论 MRI可清晰显示TCS合并脂肪瘤的分型及其内的神经纤维,其对手术具有重要的价值。     

脊髓栓系综合征的MRI表现及诊断

目的分析脊髓栓系综合征(TCS)的MRI影像学特点，评价其诊断价值。方法对16例脊髓栓系综合征患者的MRI资料进行回顾性分析。结果16例中15例脊髓低位，脊膜膨出、脊髓脊膜膨出及脂肪脊髓脊膜膨出10例，椎管内脂肪瘤3例．脊髓纵裂2例，皮样囊肿2例，脊柱裂、腰骶椎分节不全15例。结论MRI能明确显示脊髓圆锥的位置、引起栓系的原因及伴发畸形．为脊髓栓系综合征患者的手术治疗提供可靠依据。     

腰骶椎管闭合不全超声检查的应用

目的 :观察超声在腰骶椎管闭合不全合并脊髓栓系综合征中诊断和术后随访的价值。方法 :6 8例患者进行腰骶椎管超声检查 ,同时有脊髓造影 CT或磁共振 (MRI)确诊并经手术证实进行对比评价 ;对术后 30例随访超声观察。结果 :超声可同样检查 CT或 MRI显示本症的特征 ,低位脊髓、脊髓背移、椎管内脂肪瘤或囊性脊椎裂的病变异常 ;同时超声尚能检查出脊髓远端动态脉跳搏动消失。超声诊断正确率为 85 .3%。术后随访 30例中有 3例可能术后粘连致再栓系。结论 :超声可作为无损伤早期初筛诊断 ,尤为可疑婴幼儿和儿童的应用 ,并可术后随访     

儿童Currarino综合征合并脊髓栓系的诊断和治疗

目的：探讨合并脊髓栓系的儿童Currarino综合征的诊断和治疗。方法回顾2007年1月～2014年11月苏州大学附属儿童医院收治的6例合并脊髓栓系的Currarino综合征患儿临床表现、诊断和治疗。结果2例患儿术前诊断为Currarino综合征合并脊髓栓系,一期完成手术。另外4例在诊断脊髓栓系前已行肛门直肠畸形手术,术后因大小便功能改善效果不佳,磁共振检查发现合并脊髓栓系,二期行脊髓栓系松解术。5例手术顺利,术后大小便功能均有明显进步,1例因出现直肠瘘,先行乙状结肠造漏,直肠瘘口3个月后重新肠吻合后治愈。结论诊断Currarino综合征的患儿行核磁共振检查时应仔细观察是否合并有脊髓栓系,争取一期手术;对于未能在Currarino综合征术前明确合并脊髓栓系的病例,如术后患儿大小便功能改善不明显,应想到合并脊髓栓系的可能性,尽早手术。Currarino综合征合并脊髓栓系虽然病情复杂,但经过及时诊治仍能取得较好的预后。     

Spinal sonography in newborns and infants - part II: spinal dysraphism and tethered cord

Patients with cutaneous markers in the lumbo-sacral region as well as infants with bladder and bowel dysfunction, orthopedic anomalies and progressive neurological dysfunction are at risk for spinal dysraphism and tethered cord. Three types of spinal dysraphism can be distinguished: Type I - open spinal dysraphisms with a non-skin covered back mass; type II - closed spinal dysraphisms with a skin covered back mass; type III - occult spinal dysraphisms without a back mass. All spinal dysraphisms can be associated with a tethered cord, characterized by a low position of the conus medullaris below L3. Type I dysraphisms are meningomyeloceles and myeloceles, which are associated with CHIARI-II malformations characterized by the low position of the cerebellar vermis within the foramen magnum. Type II dysraphisms are lipomyeloceles, lipomyelomeningoceles, posterior meningoceles and myelocystoceles. Lipomeningoceles and lipomyelomeningoceles are characterized by a subcutaneous echogenic mass which communicates with the spinal canal and may cause tethered cord. Posterior meningoceles are, dorsal cystic space occupying lesions without internal neural tissue. Myelocystoceles are characterized by a cystic dorsal mass which communicates with a dilated central canal characteristic of syringo-hydromyelia. Type III dysraphisms without a back mass are frequently associated with cutaneous markers in the lumbo-sacral region. Sonographically dermal sinus tracts, diastematomyelia, tight filum and lipoma of the filum terminale and the caudal regression syndrome have to be distinguished. Dermal sinuses are characterized by an echogenic tract from the skin to the spinal canal, often associated with a spinal dermoid. Diastematomyelia is characterized by a complete or partial duplication of the spinal cord which can only be shown on axial images. Tight filum terminale or lipoma of the filum terminale is characterized by a thick echogenic filum with a diameter of more than 2 mm, and a conus below L3. CONCLUSION: All different forms of spinal dysraphisms and tethered cord can be diagnosed sonographically in the neonatal period as long as the spinal arches are not completely ossified.     

Prenatal diagnosis of tethered spinal cord associated with sacrococcygeal teratoma

Tethered spinal cord is mostly caused by myelomeningocele and lipomyelomeningocele, while dermal sinus tract, diastematomyelia, lipoma, tumor, thickened/tight filum terminale, spinal trauma, and spinal surgery are among the other causes. Prenatal diagnosis of tethered cord has been reported, and it is usually associated with neural tube defects. We present an atypical presentation of a tethered spinal cord, which was associated with a sacrococcygeal teratoma and was diagnosed in the 23rd week of pregnancy by ultrasonography. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44 :506–509, 2016     

脊髓髓内肿瘤术后早期脊髓功能康复的影响因素

目的探索非外伤性脊髓损伤后神经功能康复的影响因素。方法分析研究23例脊髓髓内肿瘤患者的术前脊髓功能状态、肿瘤性质、手术方法及术后早期神经功能恢复情况。结果发现良性肿瘤由于边界清楚,手术全切除率高,术后恢复较好。恶性肿瘤常浸润性生长,术中较难分辨其边界,易损伤功能脊髓组织而影响疗效。术前已完全瘫痪者,手术后神经难以改善。结论肿瘤的病理性质、切除程度、术中操作、术前脊髓功能状态等是影响脊髓功能修复的重要因素。术后早期康复训练可能加快康复速度,提高康复的程度。     

小儿脊髓栓系综合征围术期护理

目的探讨小儿脊髓栓系综合征围术期的护理方法,提高患儿的生活质量。方法对我院2008年1月至2009年1月45例脊髓栓系综合征手术治疗的患儿采取术前、术后精心护理和康复训练的措施。结果45例患儿均安全度过手术期,感觉障碍、运动障碍在术后随访中均有明显改善;3例大小便失禁患儿改善不明显;全组患儿未出现新的并发症。结论完善的术前准备、细心的术后观察、尽早期的康复训练,可最大限度地恢复脊髓神经功能,提高患儿的生活质量。     

Deafferentation hypersensitivity in the rat after dorsal rhizotomy: a possible animal model of chronic pain.

Unilateral dorsal rhizotomies were done at the cervicothoracic and lumbosacral spinal cord levels in rats. In preliminary experiments dermatome maps were determined for the roots to be sectioned. The behavior of 37 rats was observed for many months after the rhizotomies. The rats with the dorsal roots sectioned in the cervicothoracic spinal cord exhibited the following behavior: at the border of the skin adjacent to the zone of deafferentation, the rat scratched vigorously and progressively denuded the skin; self-mutilation of varying degrees occurred in the deafferented limb. In some animals scratching occurred in the contralateral skin dermatome opposite to the partially deafferented zone. The rats with the dorsal roots sectioned at the lumbosacral level exhibited hypersensitivity to cutaneous stimulation but there was no scratching or self-mutilation. These results are discussed in the light of previous similar research.