摘要
目的了解圆锥位置正常型脊髓栓系综合征(TCS)患儿的临床表现和诊治特点。方法回顾性分析19例(5～8岁)圆锥位置正常型TCS患儿的临床资料,患儿术前均行放射影像学、尿流动力学、肌电图检查,手术方式采用终丝离断加椎板成形术治疗。术后(7±2)个月复查MRI及尿流动力学,比较患儿手术前后脊髓受牵拉情况及尿流动力学各指标的变化。结果术前MRI显示TCS患儿脊髓圆锥末端位置均在L2椎体下缘以上,终丝呈弓弦样紧张。其中4例显示终丝增粗,3例显示终丝轻度脂肪变;术后显示圆锥位置无明显变化,终丝紧张解除。尿流动力学结果显示术前15例患儿存在逼尿肌过度活动,3例逼尿肌收缩乏力,1例逼尿肌部分收缩功能受损伴膀胱残余尿量增多;术后16例患儿取得较好疗效,余3例下肢情况得到改善,但尿流动力学表现改善不明显。结论圆锥末端位置正常型TCS患儿的诊断需综合考虑其临床表现、放射影像学、肌电图及尿流动力学检查结果,而尿流动力学检查是诊断的关键指标,一经明确诊断,应及早行终丝离断术治疗,椎板成形术可维持患儿脊柱正常结构。
Objective To investigate the clinical characteristics,diagnosis and management of tethered cord syndrome （TCS） with normal level conus medullaris in children. Methods Nineteen children （5 - 8 years old） with normal level conus medullaris were analyzed retrospectively. The auxiliary examinations were radiography examination,electromyogram examination and urodynamics test. Every child was surgically treated by transecting the filum terminale and laminoplasty. MRI and urodynamic index were reviewed （7 ± 2） months after operation. Compared the spinal cord tethering condition on MRI scaning and the parameters of urodynamic study preoprative anti postoperative. Results In all cases,the conus medullaris was found at the normal level（ above the body of L2 ） on MRI,the terminal ilium was tense bowstringlike in all cases,thicker in 4 cases,fatter in 3 cases. The position of conus mcdullaris showed no significant change but the filum terninale tense was released after surgery on MRI. The urodynamics test showed a overactive type of neurogenic bladder in 15 cases, detrusor contractile function partly damanaged with more residual urine volume in 1 case and detrusor debilitation in 3 cases. Sixteen out of 19 children had improved or recovered after operation ,3 children had no evident change in urodvnamics. Conclusions Diagnosis of TCS children with normal level conus medullaris should be based on clinical characteristics,physical and radiological examinations, MRI, and urodynamics test,the latter is the key index to it. When neurological signs accompany such changes,early severing of the filum is indicated regardless of conus position,the operation of opening double doors or planting bone in laminae can protect and strengthen the structure and stability of vertebral column.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第5期374-376,共3页
Journal of Applied Clinical Pediatrics
基金
河南省卫生厅科技攻关项目(200703069)
关键词
脊髓栓系综合征
尿流动力学
终丝
手术
尿失禁
tethered cord syndrome
urodynamics
ilium tenninale
surgery
urinary incontinence
