Li Hao,Fan Shuangshi,Su Jun,et al.Unilateral intervertebral space approach through small incision for the treatment of occult tethered cord syndrome in children[J].Journal of Clinical Pediatric Surgery,2021,20(12):1154-1158.[doi:10.12260/lcxewkzz.2021.12.010]
经小切口单侧椎间隙入路手术治疗儿童隐匿性脊髓栓系综合征的疗效分析
- Title:
- Unilateral intervertebral space approach through small incision for the treatment of occult tethered cord syndrome in children
- 关键词:
- 隐匿性脊髓栓系综合征; 终丝; 外科手术; 治疗结果; 儿童
- Keywords:
- Occult Tethered Cord Syndrome; Terminal Filum; Surgical Procedures; Operative; Treatment Outcome; Child
- 分类号:
- R651.2;R726.511
- 摘要:
- 目的 探讨小切口单侧椎间隙入路手术治疗儿童隐匿性脊髓栓系综合征（occult tethered cord syndrome，OTCS）的临床效果，为儿童OTCS的诊治提供参考。方法 回顾性分析2020年11月至2021年4月湖南省儿童医院神经外科经单侧椎间隙入路小切口行终丝离断术治疗的28例OTCS患者临床资料，男21例，女7例；年龄2岁8个月至11岁7个月，平均年龄（6.4±2.4）岁；收集手术前后腰骶部仰卧位及俯卧位MRI检查、术前双下肢体感诱发电位、膀胱残余尿量、术后病理等结果，随访患者术后症状改善情况。结果 28例均经单侧椎间隙入路小切口手术离断终丝，松解栓系。术前仰卧位MRI阳性率为21.4%，俯卧位MRI阳性率为100%，出院后3~6个月随访，无一例出现新发神经系统症状。术后症状总缓解率为78%（22/28），其中泌尿系统症状缓解率为72%（13/18），肠道功能障碍缓解率为92%（12/13），双下肢相关症状缓解率为100%（2/2）。结论 小切口单侧椎间隙入路终丝离断术能够改善OTCS患者临床症状，疗效确切，值得推广。腰骶部俯卧位MRI是疑似OTCS患者的重要检查手段，具有临床应用价值。
- Abstract:
- Objective To explore the clinical effect of surgical treatment through small incision of occult tethered cord syndrome (OTCS) in children, and provide reference for the diagnosis and treatment of OTCS in children.Methods The clinical data of 28 children with OTCS treated by terminal filum disconnection through minimally invasive incision from November 2020 to April 2021 were analyzed retrospectively.In total, 21 males and 7 females with the age ranged from 2 years and 8 months to 11 years and 7 months, and the average age was 6.4±2.4 years.Preoperative and postoperative MRI of lumbosacral in supine and prone position, preoperative sensory evoked potentials of lower limbs, residual urine volume of bladder, and postoperative pathological results were collected.The improvement of postoperative symptoms of patients was followed up.Results All children underwent minimally invasive incision through the unilateral intervertebral space approach to disconnect the terminal filum and loosen the tethered.28 children were followed up for 3~6 months after discharge with no new onset of neurological symptoms.The overall remission rate of postoperative symptoms was 78% (22/28);the remission rate of urinary system symptoms was 72% (13/18);the remission rate of intestinal dysfunction was 92% (12/13);the remission rate of lower limb symptoms was 100% (2/2).Conclusion Minimally invasive incision terminal filum disconnection can improve the clinical symptoms of children with OTCS.Prone position MRI is an important examination method for children with suspected OTCS, and is worthy of promotion.
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备注/Memo
收稿日期:2021-05-30。
基金项目:湖南省出生缺陷协同防治科技重大专项（编号：2019SK1010）
通讯作者:吴水华,Email:292454021@qq.com