摘要
背景:脊髓栓系综合征(TCS)的病因是脊髓和神经被牵拉,随后出现下肢感觉、运动和/或膀胱、肛门括约肌功能障碍。近年来的研究发现圆锥位置正常,即圆锥位于腰2椎体下缘以上的TCS,但由于这类TCS发病隐匿,诊断困难,常被漏诊误诊。目的:对圆锥位置正常型脊髓栓系综合征的病例进行统计分析,明确其发病特点,以期帮助临床医师对TCS更加深刻的理解并及时对TCS进行诊断,减少误诊漏诊。方法:检索并阅读1956年8月至2017年7月PubMed数据库所有TCS相关英文全文文献,共纳入127篇文献,341例TCS病例,其中记录圆锥位置的有208例。仔细阅读文献,记录TCS患者的基本资料、圆锥位置、临床表现,通过SPSS软件对圆锥位置正常和低位圆锥型TCS病例的临床资料进行统计分析。结果:341例TCS病例中记录圆锥位置208例(61.0%),其中圆锥位置正常型36例(17.3%),低位圆锥型172例(82.7%)。36例圆锥位置正常型TCS病例中脂肪瘤浸润、终丝变性、脊柱裂是前3位病因;172例圆锥低位型TCS病例中脂肪瘤浸润、椎管内术后、终丝变性是前3位病因。由脊髓纵裂引起的圆锥位置正常型TCS病例数明显多于圆锥低位型TCS病例数(P=0.020)。二者在脂肪瘤、非脂肪瘤性肿块、酒窝样凹陷、多毛、皮窦、皮赘、皮肤色素沉着、腰骶部尾样结构、疼痛、鞍区感觉异常、下肢功能异常、大小便功能异常及膝反射和肛门反射异常等没有明显的统计学差异。圆锥位置正常TCS病例中腰骶部血管瘤病例(11.1%)明显多于圆锥低位TCS病例(0.6%, P=0.003);圆锥低位型TCS下肢感觉异常的病例(44.8%)明显多于圆锥正常位置型TCS的病例(19.4%,P=0.005);圆锥低位型TCS跟腱反射亢进的病例(2.3%)明显少于圆锥正常位置型TCS的病例(13.9%,P=0.009);圆锥低位型TCS跟腱反射减弱的病例(19.2%)明显多于圆锥正常位置型TCS的病例(5.6%)(P=0.047)。结论:对于表现为TCS的病�
Background: The etiology of tethered cord syndrome (TCS) is the traction of the spinal cord and nerves, thereafter abnormal sense and motor of lower limbs and/or bladder-anal sphincter dysfunction occur. Recent studies have found that there is TCS with the conus medullaris (CM) in normal position (the CM was located over lumbar 2 vertebral body), which is of-ten misdiagnosed or wrong diagnosed for its concealed occurrence and difficult diagnosis. Objective: To investigate the mani-festation of TCS with normal CM position, and help clinicians further understand the disease and avoid wrong diagnosis and misdiagnosis. Methods: All English literatures in PubMed database about TCS were retrieved and read. A total of 127 articles involving 208 cases which recorded the CM position were collected. The medical data, CM position and clinical manisfestation were recorded by carefully reading the literatures, and the differences were analyzed by SPSS software between the normal and low CM position in TCS patients. Results: Of 341 patients with TCS, 208 patients had their CM position recorded (61.0%), in-cluding 36 patients of normal CM position (17.3%) and 172 patients of low CM position (82.7%). Lipoma infiltration, terminal filament degeneration and spina bifida were the top three causes of TCS in 36 patients with normal CM position. Lipoma infil-tration, spine surgery and terminal filament degeneration were the top three causes of TCS in 172 patients with low CM posi-tion. The number of TCS patients with normal CM position caused by diastematomyelia was significantly higher than that of pa-tients with low CM position (P=0.020). There was no significant difference in lipomyoma, non-lipomyoma lump, dimpled de-pression, pilosity, dermal sinuses, skin tag, skin pigmentation, caudal structures of the lumbosacral region, pain, paresthesia of sellar region, dysfunction of lower limbs, abnormal fecal and urinary functions and abnormal of knee jerk and anal reflex be. tween the two groups. The number of lumbosacral hemangioma and
作者
陈可夫
卢一玮
钱维
刘文德
岳玮
王珂
贾连顺
陈雄生
CHEN Kefu;LU Yiwei;QIAN Wei;LIU Wende;YUE Wei;WANG Ke;JIA Lianshun;CHEN Xiongsheng(Department of Orthopedics, No. 988 Center Hospital of the Chinese People's Liberation Army, Zhengzhou 450000;Operation Room, Changzheng Hospital, Second Military Medical University, Shanghai 200000;Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200000;Medical Services Section, No. 988 Center Hospital of the Chinese People's Liberation Army, Zhengzhou 450000;Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200000, China)
出处
《中华骨与关节外科杂志》
2018年第12期887-891,共5页
Chinese Journal of Bone and Joint Surgery
关键词
脊髓栓系综合征
圆锥位置正常
病例分析
诊断
Tethered Cord Syndrome
Normal Conus Medullaris Position
Case Analysis
Diagnosis
