CAJ | 학술논문

目的：回顾性分析27例儿童脊髓栓系综合征患者的手术疗效，评价神经电生理监测在显微手术治疗脊髓栓系综合征中的作用和意义。方法全部27例术前均经MRI诊断为脊髓栓系综合征，其中8例为低位脊髓圆锥、终丝短粗或伴有脊髓外翻，无明显神经功能障碍；19例伴有脊髓脂肪瘤/血管脂肪瘤者有神经功能障碍，主要表现为小便功能障碍和下肢运动功能障碍。全部患者均在术中神经电生理监测下行脊髓松解术，术中持续监测肌电图，并以神经刺激器主动刺激鉴别终丝和神经根。术后随访20～62个月，平均35.3个月，对患者术前及术后不同临床症状进行配对t检验和Cochran-Mantel-Haenszel检验分析。结果全部病例术后临床症状均无加重，19例伴有脂肪瘤的患者中，14例（73.7%）改善，5例（26.3%）无明显改善，11例（57.9%）脂肪瘤全切除，8例（42.1%）大部分切除。结论显微手术中，神经电生理监测技术有助于对正常神经组织与栓系因素界面的辨别，可使神经外科医生对脊髓栓系与正常的终丝和神经根等进行最大程度的松解，并获得更好的疗效。
목적：회고성분석27례인동척수전계종합정환자적수술료효，평개신경전생리감측재현미수술치료척수전계종합정중적작용화의의。방법전부27례술전균경MRI진단위척수전계종합정，기중8례위저위척수원추、종사단조혹반유척수외번，무명현신경공능장애；19례반유척수지방류/혈관지방류자유신경공능장애，주요표현위소편공능장애화하지운동공능장애。전부환자균재술중신경전생리감측하행척수송해술，술중지속감측기전도，병이신경자격기주동자격감별종사화신경근。술후수방20～62개월，평균35.3개월，대환자술전급술후불동림상증상진행배대t검험화Cochran-Mantel-Haenszel검험분석。결과전부병례술후림상증상균무가중，19례반유지방류적환자중，14례（73.7%）개선，5례（26.3%）무명현개선，11례（57.9%）지방류전절제，8례（42.1%）대부분절제。결론현미수술중，신경전생리감측기술유조우대정상신경조직여전계인소계면적변별，가사신경외과의생대척수전계여정상적종사화신경근등진행최대정도적송해，병획득경호적료효。
Objective Retrospectively analysing the efficacy and the utility of the surgery on tethered spinal cord syndrome (TSCs) of children, to explore the value of intraoperative electrophysiological monitoring (EPG) guiding microsurgery on TSCs of children.MethodsFrom January 2008 to July 2011, 27 children mean aged 3.5 years (range 3 d-12 y) with TSCs underwent microsurgery guided by intraoperative EPG. All patients were diagnosed by MRI before operation. 8 patients appeared lower conus medullaris, filum terminale short, or spinal cord eversion, and no obvious neurological deficits. 19 patients appeared TSCs with spinal lipoma/angiolipoma, and obvious neurological deficits, including sphincter disturbances and lower limb motor dysfunction.In all cases, both passive (electromyography) and active (detection of compound muscle action potentials) electrophysiological monitoring was used. Clinical symptom were reviewed to evaluate the utility of electrophysiological guidance and patient outcomes.ResultsAll patients underwent surgery untethering of spinal cord guided by intraoperative EMG, and were followed up for mean 35.3 months (range 20-62 months). In patients having neurologic deficits, 14/19(73.7%) improved, 5/19(23.3%) remained stability(χ2=17.043, P<0.01), and there were no worsen case. In patients with lipoma/angiolipoma, 11/19(57.9%) were total resection, and 8/19(42.1%) were partly resection. ConclusionsSurgical untethering of TSCs halts progression and often improves preoperative symptoms. Intraoperative EPG monitoring of microsurgery can effectively distinguish normal neural tissue and the tethering factors, distinguish filum terminale and nerve root, can help maximumly to release the spinal cord, achieve the best curative effect.