21例儿童脊髓栓系综合征的诊断和治疗

目的:讨论儿童脊髓栓系综合征的诊断及治疗。方法:回顾性分析21例脊髓栓系综合征的临床资料、诊断依据、X线平片及MRI。手术方法均采用终丝切断术。结果:外观上腰背部隐性脊柱裂特有的皮肤改变16例,X线平片18例有隐性脊柱裂,MRI显示终丝脂肪变性9例,纤维变性12例,圆锥低位13例,正常位置8例,均予手术治疗。除1例无变化外,其余患者症状均有改善或恢复正常。结论:脊髓栓系综合征的诊断靠临床表现,脊柱平片及MRI,终丝有否病变是诊断的标准,而圆锥低位不是判断有无脊髓栓系综合征及是否需要手术的唯一关键指标。对于终丝变性,无论有无神经损害症状,均应尽早手术,手术方法终丝切断。

The diagnosis and treatment of tight filum terminale syndrome in 21 children

Objective: To study the diagnosis and treatment of tight filum terminale syndrome in children. Methods: Reviewed the clinical data, diagnosis, plain spine radiography and magnetic resonance imaging (MRI) of 21 patients with tight filum terminale syndrome. All patients underwent operation of filum terminale cut. Results: Of all patients, characteristic skin changes of occult spinal bifida were found in 16 patients, and plain radiography showed the spinal bifida in 18 patients. According the MRI, filum terminale was infiltrated by fat in 9 patients and by fibrous tissue in 12 patients, meanwhile 13 patients' conus were showed at lower level and 8 patients' normal. All patients except one had improved or recovered after the operation. Conclusions: The diagnosis of tight filum terminale syndrome bases on clinical features, plain spine radiography and MRI findings, and the main diagnosis criterion is that there were lesions on filum terminale. The lower level of conus should not been the only important character to diagnose tight filum terminale syndrome and to indicate the operation. Whatever, patients suffered from tight filum terminale syndrome should be operated to cut the filum terminale as early as possible even if they did not manifest neurological symptom.