摘要
目的探讨圆锥脂肪瘤型脊髓栓系综合征(TCS)的分型和手术治疗方法。方法对25例圆锥脂肪瘤型TCS患者进行回顾性研究。其中男14例,女11例,年龄4个月～48岁。并按Arai法分型。均行脊髓栓系松解、椎管内脂肪瘤切除手术,对于皮下脂肪瘤酌情作部分切除。平均随访3．2年。结果术中所见与术前MRI表现相同。脊髓尾侧型及脊髓背侧型16例,混合型2例患者完全松解栓系；5例混合型及2例脂肪脊髓脊膜膨出型脂肪瘤者行大部分切除。术后6例患者Hoffman分级明显改善。1例混合型脂肪瘤患者症状加重。4例肢体乏力明显改善,其中3例为脊髓尾侧型患者,1例为复合型患者；2例为小便失禁明显改善,1例为脊髓尾侧型,1例为混合型患者,小便失禁的病程均＜6个月。术后2例发生脑脊液漏,1例混合型及1例脂肪脊髓脊膜膨出型脂肪瘤患者发生再栓系。结论合理的分型有助于预测手术难度及患者预后；保留部分皮下脂肪瘤有利于防治脑脊液漏；病理类型复杂者容易发生再栓系,但可通过扩大硬膜囊、高分子材料修补防治；术后症状改善因病理类型不同而异,病理类型简单,病程短的患者括约肌功能障碍恢复良好。
Objective To discuss the clinical classification and surgical treatment for tethered cord syndrome（TCS） casued by conus lipomas. Method A retrospective study was made in which 25 patients with TCS casued by conus lipomas were reviewed, 14 male and 11 female patients included, who ranged from 4 months to 48 years in age. All of them were typed by Arai＇ s system and underwent untethering surgery of the spinal cord. Subcutaneous lipomas were resected in the extent according to the lumbosacral skin condition. The cases were offered 3.2 years of a mean postoperative follow-up period. Result Intraoperative findings were similar to the preoperative MRI manifestations. During the operations, 16 patients of dorsal type or caudal type and 2 of combined type lipoma were completely untethered, while 5 patients of combined type and 2 of lipemyelomeningocele type lipoma were prevented satisfactory surgical removal of the lipema. Leakage of cerebrospinal fluid was observed in 2 cases, and retethered spinal cord in 1 combined type and 1 lipomyelomeningocele patient respectively. 6 cases were obviously improved postoperatively, 4 in leg paralysis and 2 in aconuresis. However, 1 patient with combined type lipemas developed neurological deterioration just after surger. Conclusion Proper typing system could contribute to predicting difficulty of untethering operation and prognosis of TCS patients preoperatively. It was useful to avoid leakage of cerebrospinal fluid to prevent complete removal of subcutaneous lipemas. Patients with complicated anatomy of the lesion tended to develop retethering, which could be prevented by enlarge dura sac by high polymer material. Neurological defect could be impreoved postoperatively according to the pathological type. Great progress could be seen in sphincter dysfunction in patients with simple anatomy of the lesion and short period of defect.
出处
《脊柱外科杂志》
2006年第5期262-265,共4页
Journal of Spinal Surgery
关键词
神经管缺损
脂肪瘤
诊断
外科手术
neural tube defects
lipoma
diagnosis
operative surgical procedures
