成人脊髓栓系综合征的诊治

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床诊断和治疗。方法回顾性报告１８例成人脊髓栓系综合征的临床资料。所有患者均经ＭＲＩ证实并行手术松解；根据手术所见和影像学分析其致病机理及手术要点。结果脊髓或圆锥的栓系原因各不相同，包括椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月～５年随访，其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ。术中应避免损伤圆锥和马尾神经。病程过长及再栓系是疗效不佳的主要原因。

Diagnosis and Treatment of Tethered Cord Syndrome in Adults

Objective To study the clinical diagnosis and treatment of tethered cord syndrome (TCS)in adults. Methods The clinical data of 18 adults with TCS were reviewed. All patients were confirmed bypreoperative MRI and the tethered conus were released surgically. The pathological mechanism and main pointof operation were analysed according to the operative findings and the radiological data. Results The cord orconus is tethered by different factors which include intradural tumors (6 cases), myelomeningocele (6 cases),thickened filum terminale (3 cases) , diastematomyelia (2 cases) and postoperative adhesion (1 case} . Forteenof 18 cases obtained good results after 8 months to 5 years follow-up. Conclusions Clinical manifestationand prognosis of TCS in adults are different from that of TCS in children. Attention should be paid to avoidadditional injury to cord and conus during operation. The duration from onset to operation and the retethering ofthe conus are the main reason leading to dissatisfied outcome.