中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (1): 149-155.doi: 10.4103/1673-5374.243720

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

儿童脊髓拴系综合征326个病例的显微外科手术疗效：一项回顾性分析

  

  • 出版日期:2019-01-15 发布日期:2019-01-15
  • 基金资助:

    中国人民解放军总医院军事医学研究与临床研究基金会科学基金（2016FC-CXYY-1006，Z171100001017140，基金负责人：尚爱加)。

Microsurgical efficacy in 326 children with tethered cord syndrome: a retrospective analysis

Ai-Jia Shang1, Chang-Hao Yang1, Cheng Cheng1, Ben-Zhang Tao1, Yuan-Zheng Zhang2, Hai-Hao Gao1, Shao-Cong Bai1   

  1. 1 Department of Neurosurgery, PLA General Hospital, Beijing, China
    2 Department of Neurosurgery, Yanan University Affiliated Hospital, Yanan, Shaanxi Province, China
  • Online:2019-01-15 Published:2019-01-15
  • Contact: Ai-Jia Shang, MD, shangaj@126.com.
  • Supported by:

    This study was supported by the Science Foundation of Military Medical Research and Clinical Research Foundation of PLA General Hospital in China, No. 2016FC-CXYY-1006 (to AJS); a grant from the Application of Clinical Features of Capital City of Science and Technology Commission in China, No. Z171100001017140 (to AJS).

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摘要：

脊髓拴系综合征是一种进展性疾病，儿童及婴幼儿起病隐匿，神经功能障碍呈进行性加重，如不及时手术治疗致残率高。为探讨不同临床分型儿童脊髓拴系患者的显微外科手术效果差异，我们对326例年龄为2个月-14岁的脊髓拴系患者进行了为期3-36个月的术后随访工作。(1)根据临床表现和影像学特征我们将患者分为5种分型：单纯终丝增粗型53例，脂肪脊髓脊膜膨出型55例，脂肪瘤型124例，术后瘢痕黏连型56例和脊髓纵裂型38例，所有患者均接受显微外科手术治疗；(2)我们分别于术前和手术后3个月，采用基于感觉和运动功能、反射、排尿及排便功能的脊柱裂神经量表（SBNS）评分作为结局指标对患者进行疗效及预后评估；(3)结果显示各分型脊髓拴系患者术后的SBNS评分均优于术前。全部患者的总有效率为75%，单纯终丝增粗型为91%，脂肪脊髓脊膜膨出型为84%，脂肪瘤型为65%，瘢痕黏连型为75%，脊髓纵裂型为79%。二元logistic回归分析显示脊髓拴系的临床分型（是否为脂肪瘤）和术前病程（长短）为手术疗效的独立影响因素；(4)上述数据说明，不同临床分型脊髓拴系综合征患者的手术疗效具有明显差异，因此对脊髓拴系综合征手术治疗患者进行临床分型，有助于预测预后结局并指导精准治疗。文章已经于中国临床试验注册中心注册（注册号：ChiCTR1800016464）。

orcid: 0000-0003-0002-5331(Ai-Jia Shang)

关键词: 脊髓拴系综合征, 手术, 治疗, 预后, 儿童患者, 手术效果, 手术方法, 预防性手术, 脊柱裂

Abstract:

Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3–36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight filum terminale (53 cases), lipomyelome¬ningocele (55 cases), lipomatous malformation (124 cases), postoperative adhesions (56 cases), and split cord malformation (38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight filum terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal¬formation. Binary logistic regression analysis revealed that types of tethered cord syndrome (lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800016464).

Key words: nerve regeneration, tethered cord syndrome, surgery, therapy, prognosis, children patients, surgical outcome, surgical methods, prophylactic surgery, spina bifida, neural regeneration