CAJ | 학술논문

目的探讨脊柱均匀短缩脊髓轴性减压术(HSAD)对脊髓栓系综合征(TCS)的治疗效果.方法对2010年4月至2014年7月在第二军医大学附属长征医院脊柱外科行HSAD的15例连续TCS患者的手术效果进行回顾性研究.使用尿流动力学检查、磁共振弥散张量成像、下肢肌电图、专科体格检查、视觉模拟评分量表(VAS)等,评价患者的神经功能恢复包括膀胱功能、下肢感觉功能、下肢运动功能、下腰或下肢痛等术前症状的恢复情况.结果全部患者的平均随访时间为21.5个月.平均脊柱缩短长度为(17.2±2.9)mm.11例患者的下肢运动功能障碍在术后都有显著提高.9例腰痛和下肢疼痛症状得到较大程度缓解.9例有疼痛主诉的患者VAS疼痛评分在术后都有显著下降.15例患者在最后一次随访中都达到了截骨处完全的骨性融合.术后不能完全恢复的症状为足下垂(2例)、膀胱功能障碍(9例)和下肢感觉功能障碍(4例).尽管膀胱功能未得到完全恢复,但在术后5例患者(55.6％)膀胱顺应性增高,安全容量增加,4例(44.4％)患者括约肌肌电图结果得到明显改善.结论 HSAD通过均匀短缩脊柱达到对受栓系的神经组织直接的轴性减压.切断终丝是导致症状加重的原因之一.TCS占位组织长期处于稳定状态的患者,不是导致症状加重的原因,传统的终丝切断马尾松解手术应慎重选择.
목적 탐토척주균균단축척수축성감압술(HSAD)대척수전계종합정(TCS)적치료효과.방법 대2010년4월지2014년7월재제이군의대학부속장정의원척주외과행HSAD적15례련속TCS환자적수술효과진행회고성연구.사용뇨류동역학검사、자공진미산장량성상、하지기전도、전과체격검사、시각모의평분량표(VAS)등,평개환자적신경공능회복포괄방광공능、하지감각공능、하지운동공능、하요혹하지통등술전증상적회복정황.결과 전부환자적평균수방시간위21.5개월.평균척주축단장도위(17.2±2.9)mm.11례환자적하지운동공능장애재술후도유현저제고.9례요통화하지동통증상득도교대정도완해.9례유동통주소적환자VAS동통평분재술후도유현저하강.15례환자재최후일차수방중도체도료절골처완전적골성융합.술후불능완전회복적증상위족하수(2례)、방광공능장애(9례)화하지감각공능장애(4례).진관방광공능미득도완전회복,단재술후5례환자(55.6％)방광순응성증고,안전용량증가,4례(44.4％)환자괄약기기전도결과득도명현개선.결론 HSAD통과균균단축척주체도대수전계적신경조직직접적축성감압.절단종사시도치증상가중적원인지일.TCS점위조직장기처우은정상태적환자,불시도치증상가중적원인,전통적종사절단마미송해수술응신중선택.
Objective Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome.However,such complications as cerebrospinal fluid leakage and neurologic deterioration are common.Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegrnental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly.The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome.Methods The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014.Improvements of neurological symptoms including urinary dysfunction,lower-extremity motor and sensory disturbances and/or gait abnormalities,low-back and/or lower-extremity pain,bowel incontinence and sexual dysfunction were evaluated.Results Their average follow-up period was 21.5 months.The length of spinal column shortening was 17.2 ± 2.9 mm.Urinary dysfunction (n =9) was the most common residual deficit.All 9 patients with urological symptoms reported improvements,although deficits persisted at the last follow-up.All patients with lower-extremity motor dysfunction improved and 4 (50.0％) noted complete resolution of preoperative lower-extremity sensory symptoms.All patients reported immediate low-back or lower-extremity pain relief after HSAD.One patient reported improved sexual functioning and regained complete erectile capabilities.Two patients (11％) experienced less satisfactory symptomatic or functional benefit from HSAD.However,the main objective of surgery was to prevent further worsening of neurological status.Complete bone union at osteotomy site was noted in all cases at the last follow-up.Conclusion As a novel surgical option for tethered cord syndrome,HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery.All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.