摘要
目的探讨终丝牵张型脊髓拴系综合征按照MRI分型进行显微手术治疗的效果。方法回顾性分析2007年1月~2019年7月69例终丝牵张型脊髓拴系综合征的临床资料。根据MRI分为3型:Ⅰ型为单纯终丝牵张型,23例;Ⅱ型为合并骶管终丝囊肿型,32例;Ⅲ型为合并末端脊髓空洞症型,14例。术前Hoffman评分0级26例,1级24例,2级19例。Ⅰ型行单纯显微手术终丝分离并切断;Ⅱ型行终丝切断、骶管囊肿切除、脊髓拴系松解术;Ⅲ型行终丝切断、脊髓拴系松解、脊髓空洞引流、脊膜囊重建术。结果无手术并发症发生。术前疼痛44例,出院时视觉模拟评分(Visual Analogue Scale,VAS)从术前的(6.37±3.50)分降到(2.10±3.72)分,其中9例疼痛消失。术前运动障碍38例,出院时肌力提高1级15例,2级7例,3级4例,4级3例,其余9例无变化。术前大小便功能障碍26例,出院后3个月随访时日本骨科学会(Japanese Orthopaedic Association,JOA)膀胱括约肌评分从(1.36±2.21)分上升到(2.15±1.96)分。术前体位性低颅压头痛2例,出院时症状均消失。69例随访6个月~12年,平均5.1年,其中33例>5年。神经功能Hoffman分级0级47例,1级18例,2级4例。未见拴系复发。结论终丝牵张型脊髓拴系综合征根据影像学表现分为单纯终丝牵张型、合并骶管终丝囊肿型和合并末端脊髓空间症型3型,显微镜下行终丝分离切断、脊髓拴系松解及脊膜囊重建,疗效满意。
Objective To investigate the outcome of microsurgical treatment of tethered cord syndrome due to filum terminale traction according to magnetic resonance imaging(MRI)classification.Methods The authors retrospectively analyzed a series of 69 patients with tethered cord syndrome due to filum terminale traction surgically treated under microscope from January 2007 to July 2019.They were divided into three types by preoperative MRI features:typeⅠshowed filum terminale traction and low-lying conus medullaris in 23 cases;typeⅡrevealed meningeal cyst of filum terminale and low-lying conus medullaris in 32 cases;typeⅢpresented with filum terminale traction and terminal syringomyelia of spinal cord in 14 cases.There were grade 0 in 26 patients,grade 1 in 24 patients,and grade 2 in 19 patients,evaluated by the Hoffman grading system.Operations had been performed including resection of the filum terminale for typeⅠ,in addition to resection the meningeal cyst and de-tethering the spinal cord for typeⅡ,and further drainage of the cerebrospinal fluid(CSF)in syringomyelia for typeⅢ,and reconstruction of the end of dural sac as well.Results There was no operative complication happened.Of the 44 patients with preoperative local pain,the Visual Analogue Scale(VAS)was decreased from(6.37±3.50)points preoperatively to(2.10±3.72)points postoperatively,including 9 patients with pain disappeared.Of the 38 patients with lower limbs weakness,the strength was increased by 1 grade in 15 patients,2 grades in 7 patients,3 grades in 4 patients,and 4 grades in 3 patients,with other 9 patients having no change upon discharge.Of the 26 patients with sphincter dysfunction,the Japanese Orthopaedic Association(JOA)score was increased from(1.36±2.21)preoperatively to(2.15±1.96)at 3 months post-operation follow-up.The 2 patients with symptom of postural hypotensive intracranial pressure headache had been resolved upon discharge.The period of follow-ups ranged from 6 months to 12 years(average,5.1 years),and 33 patients had more than 5
作者
谢京城
陈晓东
杨军
Xie Jingcheng;Chen Xiaodong;Yang Jun(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第7期577-580,共4页
Chinese Journal of Minimally Invasive Surgery
