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成人脊髓栓系综合征的诊治 |
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石志才 袁文 贾连顺 李家顺 侯铁胜 倪斌
【摘要】目的 研究成人脊髓栓系综合征(TCS)的临床诊断和治疗。方法 回顾性报告18例成人脊髓栓系综合征的临床资料。所有患者均经MRI证实并行手术松解；根据手术所见和影像学分析其致病机理及手术要点。结果 脊髓或圆锥的栓系原因各不相同，包括椎管内肿瘤(6例)、脊髓脊膜膨出(6例)、终丝增粗(3例)、脊髓双裂畸形(2例)及术后粘连(1例)。经8个月～5年随访，其中14例获得满意疗效。结论 成人TCS在临床表现及预后等方面有别于幼儿TCS。术中应避免损伤圆锥和马尾神经。病程过长及再栓系是疗效不佳的主要原因。
【关键词】脊髓栓系综合征 外科，手术 诊断
Diagnosis and Treatment of Tethered Cord Syndrome in Adults
SHI Zhicai*, YUAN Wen, JIA Lianshun, et al.
*Department of Orthopaedics, Changhai Hospital, Shanghai 200433
【Abstract】 Objective To study the clinical diagnosis and treatment of tethered cord syndrome(TCS) in adults. Methods The clinical data of 18 adults with TCS were reviewed.All patients were confirmed by preoperative MRI and the tethered conus were released surgically. The pathological mechanism and main point of operation were analysed according to the operative findings and the radiological data. Results The cord or conus is tethered by different factors which include intradural tumors (6 cases), myelomeningocele (6 cases), thickened filum terminale (3 cases),diastematomyelia (2 cases) and postoperative adhesion (1 case).Forteen of 18 cases obtained good results after 8 months to 5 years follow-up. Conclusions Clinical manifestation and prognosis of TCS in adults are different from that of TCS in children. Attention should be paid to avoid additional injury to cord and conus during operation. The duration from onset to operation and the retethering of the conus are the main reason leading to dissatisfied outcome.
【Key words】 Tethred cord syndrome Surgery,operative Diagnosis
由于各种先天性和后天性原因牵拉脊髓或圆锥，使圆锥下降并产生一系列神经功能障碍和畸形的症候群称为脊髓栓系综合征(tethered cord syndrome,TCS)。TCS多见于幼儿及青少年，成人相对少见，临床上易误诊、漏诊。1991年3月～1996年6月我们诊治了18例成人TCS，其临床特征有别于幼儿TCS。
临床资料
一、诊断标准
(1)首发神经损害症状时年龄大于18岁，此前无或无明显感觉、运动障碍；(2)神经损害范围广泛，不能用单一神经根损害来解释；(3)影像学检查证明脊髓圆锥低于L2下缘。
二、一般资料
本组男8例，女10例，年龄18～51岁，平均32.6岁。[1] [2] 下一页
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