脊髓栓系综合征后遗马蹄内翻足64例

目的分析儿童脊髓栓系综合征(TCS)后遗马蹄内翻足的临床特点,并对其疗效进行评估。方法对2005年5月-2010年12月手术治疗的64例TCS后遗马蹄内翻足畸形患儿的病例资料进行回顾性研究,从发病情况、临床表现、并发症、手术方式等几个方面进行分析,并根据国际马蹄内翻足畸形研究学组(ICFSG)的评分标准对其进行疗效评估。结果单侧足受累35例(左侧13例,右侧22例),双侧足受累29例。原发型TCS 53例,继发型TCS 11例。并发症:感觉障碍者26例,大小便功能障碍者23例(部分丧失18例,失禁5例),并发育性髋关节脱位和肌营养不良者1例,小脑扁桃体疝2例,脊柱侧弯10例,肋骨发育畸形3例和脊髓空洞22例。疗效:优10例16足,良21例36足,可25例31足,差8例10足。本组病例中,11例既往在多家医院未能明确发病原因,误诊或者漏诊率为17.2%(11/64例)。结论儿童TCS继发足畸形以马蹄内翻足居多。临床误诊漏诊现象较普遍,应提高对该病的认识,明确病因及对因治疗至关重要。

Clinical Analysis of Talipes Equinovarus Caused by Tethered Cord Syndrome in 64 Children

Objective To analyze the clinical features of children with talipes equinovarus caused by tethered cord syndrome(TCS) and assess their effects.Methods The clinical data of 64 children with talipes equinovarus caused by TCS who suffered surgery were researched retrospectively from May 2005 to Dec.2010,whose incidence,clinical manifestations,complications and operative methods were analyzed,and effects were also evaluated in accordance with international clubfoot studies group(ICFSG).Results Unilateral foot deformity in 35 cases(left in 13 cases,right in 22 cases),bilateral foot deformity in 29 cases.Primary TCS in 53 cases,secondary TCS in 11 cases.Complications:26 cases of sensory disturbance,bowel and bladder dysfunction in 23 cases(partial loss in 18 cases,incontinence in 5 cases),deve-lopmental dislocation of the hip and muscular dystrophy in 1 case,tonsillar herniation in 2 cases,scoliosis in 10 cases,rib malformations in 3 cases and syringomyelia in 22 cases.Excellent in 10 cases 16 feet,good in 21 cases 36 feet,moderate in 25 cases 31 feet,worse in 8 cases 10 feet.Eleven patients had failed in other hospitals,the rate of misdiagnosed or missed diagnosis was 17.2%(11/64 cases).Conclusions Talipes equinovarus is the majority of foot deformity caused by TCS in children.Clinical misdiagnosis or missed diagnosis is very common,so should raise awareness of the disease,to find its etiology and etiological treatment is essential.