BAO Nan,WU Shui-hua,YANG Bo,et al.Diagnosis and treatment of tight filum terminale syndrome in children.[J].Journal of Clinical Pediatric Surgery,2010,9(04):0.
儿童终丝牵拉综合征60例诊治分析
- Title:
- Diagnosis and treatment of tight filum terminale syndrome in children.
- Keywords:
- Neural Tube Defects; Diagnosis; Therapy
- 摘要:
- 目的 探讨不同位置儿童终丝牵拉综合征及伴随脊柱裂畸形的诊断和治疗方法。方法 分析60例终丝牵拉综合征患儿的临床资料、诊断依据、临床表现、X线平片及MRI检查结果，其中21例圆锥在正常位置，18例圆锥低位，21例圆锥低位伴腰骶部椎管内脂肪瘤畸形，比较3组患儿病情，包括腰骶部皮肤特征、椎体畸形、是否合并其他先天性脊柱裂畸形、下肢畸形、括约肌功能障碍以及手术前后神经功能的改变。结果 3组在椎体畸形、下肢畸形的发生率以及神经功能损害和手术后恢复方面无明显区别，在腰骶部皮肤特征性表现发生率、是否合并其他先天性脊柱裂畸形方面，有明显区别。3组病例手术治疗均有效果。结论 终丝牵拉综合征圆锥可以在正常位置，MRI不是判断终丝有否病变的唯一标准，还需综合考虑临床表现、体检、脊柱X线平片及MRI检查结果。对于终丝变性，尤其有神经症状者，无论圆锥位置如何，均应尽早手术。手术方法为终丝切断术。
- Abstract:
- Objective Tight filum terminale syndrome (TFTS) characterized by findings consistent with a tethered cord but with the conus ending in a normal position has only recently been observed in children. In this situation, diagnosis may prove difficult and sectioning of the filum terminale is questionable. Methods Sixty cases of pediatric TFTS were analyzed by methods including spinal X-ray and MRI. Twenty-one patients exhibited a normally positioned conus, 18 a low-lying conus cases, and 21 a low-lying conus cases accompanying lumbosacral lipoma. These three groups were compared pre- and post-operatively for lumbosacral cutaneous stigmata, vertebral anomalies, concomitant congenital spinal dysraphisms, lower limb deformities, and sphincter dysfunction. Results Rates of occurrence of lumbosacral cutaneous stigmata and other concomitant congenital spinal dysraphisms differed significantly among these groups. Differences in other parameters were not observed. All groups responded positively to surgery. Conclusions Pediatric TFTS may involve a normally positioned conus. Diagnosis of pediatric TFTS should be based on clinical presentation, physical and radiological examinations, MRI, and pathologic changes in the filum. When such changes are accompanied with neurological signs, early severing of the filum is indicated regardless of conus position.
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备注/Memo
1，上海交通大学医学院附属上海儿童医学中心神经外科（200127）；2，湖南省儿童医院外科（410007），E-mail: shbbx@online.sh.cn