儿童脊髓拴系综合征的显微外科治疗

目的 研究显微手术治疗儿童脊髓拴系综合征的疗效。方法 回顾性分析35例儿童脊髓拴系综合征，平均年龄2.2岁。均伴有脊柱裂，合并单纯脊髓脊膜膨出20例，脊髓脊膜膨出合并椎管内脂肪瘤13例，畸胎瘤1例，皮样囊肿1例。行显微手术松解黏连的脊髓和神经，切断牵拉的终丝。结果 会阴部感觉异常总有效率为80．0％，排尿功能障碍总有效率为77．1％．结合矫形手术可明显改善运动障碍。结论 显微外科手术松解脊髓圆锥和马尾神经及切断牵张的终丝．是治疗儿童脊髓拴系综合征的关键．结合矫形手术可提高病儿的生存质量。

Microsurgery for tethered cord syndrome in children

Objective To investigate the therapeutic efficacy of microsurgery on tethered cord syndrome(TCS) in children.Methods 35 cases of TCS in children were analyzed retrospectively.The average age was 2.2 years old.TCS was accompanied by spina bifida in all the cases,by myelomeningocele in 20 cases,by myelomeningocele and lipoma in 13,by teratoma in one and by dermoid cyst in one.Microsurgery was performed to disassemble the adhesive spinal cord and nerve fibers,and to cut off the tethered filum terminale.Results The total effective rate was 80.0% for the patients with paraesthesia in the perineal area,and 77.1% for the patients with urinary dysfunction.The behavioral disturbance was improved in most of patients while combined with orthopedic operations.Conclusion It is crucial to disassemble the medullary cone and cauda equina nerve,and to cut off the tethered filum terminale in the microsurgery for TCS in children.Most symptoms of TCS in children can be improved significantly by microsurgery combined with orthopedic operations.