脂肪瘤型脊髓栓系综合征的手术技巧

目的 探讨脂肪瘤型脊髓栓系综合征的手术治疗技巧. 方法 自2003年至2006年,我科共收治33例脂肪瘤型脊髓栓系患者,均在电生理监测下切除脂肪瘤,显微手术分离粘连、松解脊髓,以无损伤不可吸收缝线(Prolene线,5-0)连续缝合硬脊膜,一期行硬脊膜重建;翻转腰背部筋膜行先天性缺损修补与加固. 结果 29例患者切口一期愈合:4例患者出现脂肪坏死导致皮下积液,其中2例患者出现脑脊液漏,经缝合及引流后治愈.随访1～3年,28例患者临床症状有显著改善,5例患者虽无改善亦无神经系统症状加重;复查均无再栓系形成. 结论 脂肪瘤型脊髓栓系综合征早期电生理监测下行栓系松解术,同时行硬脊膜的修补与重建,对于预防术后再栓系至关重要.

Surgical strategy of tethered cord syndrome with lipoma

Objective To explore the surgical strategy for tethered cord syndrome with lipoma.Methods Operations for releasing of tethered conus medullaris were composed of lipomas excision,adhesion releasing, terminal filum resection and reconstruction of dura mate of spinal cord. Fascia of the surrounding muscle with nonabsorbable suture (Prolene, 5-0) was used in duraplasty operation.Microsurgical release of the tethered cord was performed in each case while using multimodality intraoperative neurophysiological monitoring. Results Complication of subcutaneous fluidify included superficial wound infection in 4 patients and cerebrospinal fluid leakage in 2 patients, which were managed by reinforcement sutures and temporary external drainage. During the follow-up of 1-3years, 28 (84.8%) cases get better obviously in symptoms, and MRI re-examination showed no tethered cord in them. The other 5 cases did not suffer from an aggravation of nervous symptoms although a significant improvement was not achieved in them. Conclusions Early operation for tethered cord release should be performed under intraoperative neurophysiological monitoring to prevent the development of neurological defect. And releasing of tethered spinal cord and repairing of meningocele should be done simultaneously. Dural repair with Prolene displays significantly less cerebrospinal fluid leakage, less subcutaneous fluidity, and less extensive chronic inflammation and meningoneural adhesions.