儿童与成人脂肪瘤型脊髓拴系综合征的疗效对比性分析

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。

The comparative analyze of curative effect of lipoma tethered cord syndrome between children and adults

Objective To compare the therapeutic effect of microsurgery treatment of lipoma tethered cord syndrome between children and adults by analyzing the clinical data of 611 cases.Methods 611 cases with lipoma tethered cord syndrome were classified into group child and group adult from January 2004 to January 2010 in Yuquan Hospital of Tsinghua University.Neurological examinations,MR image,bladder post void residual and electrophysiological examination were conducted preoperatively.The microsurgical treatment with intraoperative electrophysiological monitoring was performed in all the cases.The evaluation method was divided into shortterm efficacy and long-term efficacy.The index of short-term efficacy included Hoffman grading system,Kirollos grading system and complication.The index of long-term efficacy included clinical symptoms,bladder post void residual and electrophysiological examination.The curative effect was compared between group child and group adult by the index.SPSS 16.0 was used to analyze data.Results According to Hoffman grading system,there was significant difference in improved cases between group child and group adult（P0.05）and there was significant difference in stabilized cases between group child and group adult（P0.05）,while there was no significant difference in deteriorated cases between group group child and group adult（P0.05）.According to Kirollos grading system,there was difference in Grade Ⅰ,Grade Ⅱ and Grade Ⅲ between group child and group adult（P0.05）.There were less complications in group child than group adult.There was significant difference in bladder post void residual between group child and group adult（P0.05）.There was no recurrent case in two groups by MR image in follow-up period.There was significant difference in electrophysiological examination index between group child and group adult（P0.05）.Conclusion There was better efficacy obtained by the microsurgery surgery in children than in adults.