CAJ | 학술논문

目的：探讨预防性手术治疗脊神经管畸形并脊髓栓系及其随诊观察的临床意义。方法收集2007年1月至2012年12月我们收治的300例脊神经管畸形并脊髓栓系婴儿，根据住院时间顺序、年龄、手术方式，选手术组60例为实验对象；观察组60例作为对照。两组术前均无膀胱、直肠功能障碍及双下肢感觉、运动功能障碍。手术组患儿均在显微镜下行脊髓栓系松解手术；观察组均为家属不同意行栓系松解术，只做脊膜膨出切除修补、藏毛窦、血管痣、皮赘、多毛及皮下脂肪瘤等切除手术。两组各选终丝型脊髓栓系20例；脊髓脊膜膨出型脊髓栓系20例；脂肪瘤型脊髓栓系20例。所有病例均行 MRI 检查，通过脊髓圆锥位置来判定两组脊髓栓系严重程度。术前术后均行膀胱容量及膀胱残余尿量超声、双下肢肌电图检查（新生儿不做肌电图检查）。两组术后随访1～6年，每3个月行膀胱容量及膀胱残余尿量检查。结果术前两组脊髓栓系严重程度（MRI）比较无统计学意义（P ＞0．05）。术后观察组各类型间膀胱残余尿量明显多于手术组（P ＜0．05）。手术组不同类型 TCS 随访不同时间点出现症状的例数明显少于观察组（P ＜0．05）。3岁、6岁为 TCS 病情进展变化显著期。结论脊神经管畸形并脊髓栓系婴儿行预防性栓系松解术可阻断神经功能及膀胱、直肠功能的恶化，年龄越小，治疗效果越好。
목적：탐토예방성수술치료척신경관기형병척수전계급기수진관찰적림상의의。방법수집2007년1월지2012년12월아문수치적300례척신경관기형병척수전계영인，근거주원시간순서、년령、수술방식，선수술조60례위실험대상；관찰조60례작위대조。량조술전균무방광、직장공능장애급쌍하지감각、운동공능장애。수술조환인균재현미경하행척수전계송해수술；관찰조균위가속불동의행전계송해술，지주척막팽출절제수보、장모두、혈관지、피췌、다모급피하지방류등절제수술。량조각선종사형척수전계20례；척수척막팽출형척수전계20례；지방류형척수전계20례。소유병례균행 MRI 검사，통과척수원추위치래판정량조척수전계엄중정도。술전술후균행방광용량급방광잔여뇨량초성、쌍하지기전도검사（신생인불주기전도검사）。량조술후수방1～6년，매3개월행방광용량급방광잔여뇨량검사。결과술전량조척수전계엄중정도（MRI）비교무통계학의의（P ＞0．05）。술후관찰조각류형간방광잔여뇨량명현다우수술조（P ＜0．05）。수술조불동류형 TCS 수방불동시간점출현증상적례수명현소우관찰조（P ＜0．05）。3세、6세위 TCS 병정진전변화현저기。결론척신경관기형병척수전계영인행예방성전계송해술가조단신경공능급방광、직장공능적악화，년령월소，치료효과월호。
Objetive To evaluate the clinical significance of preventive surgery and follow-up of infan-tile spinal dysraphism and tethered cord.Methods A retrospective analysis was made on 300 infants with spi-nal dysraphism and tethered cord treated in the Children’s Hospital of Hebei Province from Jan.2007 to Dec. 2012.60 cases in operation group and 60 cases in control group were divided by admission orders,ages and operation types.The cases in operation group were operated with microsurgery and the cases in control group underwent only excision of meningomyelocele,pilonidal sinus,hemangioma,tails,hirsutism,subcutaneous lipo-ma cause of the parents’disagree of releasing the spinal cord.All cases were inspected by MRI and the Teth-ered Severities were represented by the position of conus medullaris.The groups were divided into subgroup of filum terminale,meningomyelocele,and lipoma separately.All cases were inspected by Urodynamics and elec-tromyogram before and after the opration.The cases were paid 1 ~6 years follow-up and inspected by urody-namics every 3 months.Results There was no statistic difference of Tethered Severity between The two groups (P >0.05).Residual urine volume of the subgroups of operation group were lower than those of the control group (P <0.05).the numbers of symptoms-appeared cases at the follow-up time point were smaller in the subgroups of operation group that those of the control group (P <0.05).The 3rd to 6th year after birth were the key time point of symptoms appearing.Conclusions Preventive surgery of infantile spinal dysraphism and teth-ered cord can prevent the neural,vesical and rectum dysfunction,and the better results the earlier the operation.