摘要
目的 通过对125例婴儿脂肪瘤型脊髓拴系综合征临床数据分析,评价其显微外科治疗方法及疗效.方法 清华大学玉泉医院医院自2004年1月至2012年1月收治并有效随访的婴儿脂肪瘤型脊髓拴系125例,患者术前均行神经系统、MRI、残余尿及神经电生理检查,术中在电生理监测下行显微外科手术治疗.疗效评估分为近期疗效和远期疗效,近期疗效根据Hoffman功能性分级、Kirollos术中松解分级和并发症评估,远期疗效根据临床表现、MRI、膀胱残余尿和神经电生理结果进行评估.统计学通过SPSS16.0分析处理数据.结果 近期随访：按Kirollos术中松解分级评定方法：108例（86.4％）达到Ⅰ级,13例（10.4％）达到Ⅱ级,4例（3.2％）为Ⅲ级;发生并发症14例,占11.2％.远期随访：根据Hoffman功能性分级：术后无症状组、轻度症状组症状组在术前和术后差异有统计学意义（P＜0.05）,中度症状组、重度症状组在术前术后差异无统计学意义（P＞0.05）;膀胱残余尿检查在术前和术后差异有统计学意义（P ＜0.05）;MRI检查未发现脂肪瘤复发病例;神经电生理检查在术前和术后差异有统计学意义（P＜0.05）.结论 婴儿脂肪瘤型脊髓拴系综合征的显微治疗可获得较好的疗效,术中神经电生理监测可提高手术安全性.
Objective To discuss the microsurgery treatment of lipoma tethered cord syndrome in infants.Methods 125 infants with lipoma tethered cord syndrome were followed-up from Jan.2004 to Jan.2012 in Yuquan hospital of Tsinghua university.The neurological examinations,MRI image,bladder post void residual and electrophysiological examination were conducted preoperatively.The microsurgical treatment with intraoperative electrophysiological monitoring was performed in all the cases.The evaluation methods were divided into short-term efficacy and long-term efficacy.The indexes of short-term efficacy included Hoffman grading system,Kirollos grading system and complication evaluation.The indexes of long-term efficacy included clinical symptoms,bladder post void residual and electrophysiological examination.SPSS 16.0 was used to analyze data.Results The degree of untethering at microsurgery which was based on Kirollos grading system was assessed：GradeⅠin 108 cases （86.4％）,GradeⅡin 13 （10.4％）,and GradeⅢ in 4 （3.2％）.14 cases （11.2％） ocurred complications.According to Hoffman grading system,there was significant difference in group of non-symptom and mild-symptom between pre-operation and post-operation （P ＜ 0.05）.While there was no significant difference in group of moderate-symptom and severe-symptom between pre-operation and post-operation （P ＞0.05）.There was significant difference in bladder post void residual between pre-operation and post-operation.There was no recurrent case by MRI image in follow-up period.There was significant difference in clectrophysiological examination indexes between pre-operation and post-operation.Conclusions Good efficacy was obtained by microsurgery in infants with lipoma tethered cord syndrome.The intraoperative electrophysiological monitoring might improve the safety of operation.
出处
《中华神经外科杂志》
CSCD
北大核心
2014年第9期917-920,共4页
Chinese Journal of Neurosurgery
关键词
脂肪瘤
脊髓拴系
婴儿
疗效
Lipoma
Tethered cord syndrome
Infant
Curative effect
