【摘要】 目的 分析腰骶部脊髓脊膜膨出症两种术式与近期疗效之间的关系。方法 回顾性分析1989年2月～200年6月期间,采用两种术式治疗的腰骶部脊髓脊膜膨出症患儿 38例,年龄范围介于7 d～4月。其中2例伴有大小便失禁和双下肢弛缓性瘫痪。术前均摄取腰骶椎X线片,23例曾做了MRI检查,21例表现为脊髓圆锥低位或膨出于囊内。手术方法为单纯脊膜修补术18例和椎管扩大探查、脊髓拴系松解、脊膜修补术20例。对大小便失禁者分别采用Kelly评分法及Bruskewize评分法。结果 38例患儿术后平均随访3年,原有大小便失禁和双下肢弛缓性瘫痪的2例患者无明显恢复。单纯脊膜修补手术者,术后4例发生脊髓拴系综合征(Tethered cord syndrome,TCS),MRI显示脊髓圆锥在原位粘连。椎管扩大探查、脊髓拴系松解、脊膜修补术后未发生TCS病例。结论 治疗腰骶部脊髓脊膜膨出,推荐选择椎管扩大探查、脊髓拴系松解、脊膜修补术。单纯脊膜修补术术后极易导致TCS的发生。更多还原

【Abstract】 Objective To analyse the outcomes of two surgical procedures for management of meningomyelocele in lumbo-sacral region. Methods Retrospective analysis from February 1989 to June 2003, thirty-eight patients aged from 7 days to 4months with meningomyelocele in lumbosacral region underwent these two surgical procedures: only repair of spinal meninges(18 patients); and extended surgical exploration, release of tethered cord and repair of spinal meninges (20 patients). Rou-tine X-rays had been conducted to all the patiens and 23 patients had MRI examination. Among the patients, two were associ-ated with fleccid paralysis of both lower extremities and incontinence of bowel and bladder before surgery and were evaluatedaccording to Kelly and Bruskewize’s classification. Results After follow-up for mean 3 years two patients with flaccid paralys-is of both lower extremities and incontinence of bowel and bladder did not get improved postoperatively. 4 in 18 patients under-going only repair of spinal meninges developed tethered cord syndrome (TCS). MRI showed medullary cone was fixed in situ.However, the patients undergoing extended surgical exploration, release of tethered cord and repair of spinal meninges did notdevelop TCS. Conclusion Operation combined with extended surgical exploration, release of tethered cord and repair proce-dure is effective and reasonable for the treatment of meningomyelocele in lumbosacral region, while only repair of spinal menin-ges may result in TCS.更多还原