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目的探讨腰骶部脊髓脊膜膨出手术方法与疗效的关系。方法回顾性分析1989年2月～2002年11月期间,采用两种手术方法治疗的腰骶部脊髓脊膜膨出症患儿34例,年龄范围介于7d～4个月,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,19例曾做了MRI检查,17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、脊髓栓系松解、脊膜修补术16例。对大、小便失禁者分别采用Kelly评分法及Bruskewize评分法。结果34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例患儿无明显恢复。单纯脊膜修补手术者,术后4例发生脊髓栓系综合征(Tetheredcordsyndrome,TCS),MRI显示脊髓圆锥在原位粘连。椎管扩大探查、脊髓栓系松解、脊膜修补术后未发生TCS病例。结论椎管扩大探查、脊髓栓系松解、脊膜修补术,是治疗腰骶部脊髓脊膜膨出的一种较为合理的手术治疗方法。不正确的手术方法是导致腰骶部脊髓脊膜膨出术后发生TCS的重要原因。
Objective To investigate the relationship between lumbosacral spinal meningocele and curative effect. Methods From February 1989 to November 2002, 34 children with lumbosacral myelomarebral prolapse underwent two kinds of surgical procedures, ranging in age from 7 days to 4 months. Two of them Have incontinence and flaccid paralysis of both lower extremities. Preoperative lumbosacral X-ray films were taken, 19 cases had MRI examination, 17 cases showed spinal condyle low or bulging in the capsule. Surgical methods were simple meningomyxerectomy in 18 cases and spinal exploration, spinal cord lysis, meningitis repair in 16 cases. Kelly score and Bruskewize score were applied to large and incontinent persons respectively. Results The average follow-up of 34 patients was 3 years. There was no significant recovery in 2 children with incontinence and flaccid paralysis of both lower extremities. In meningitis alone, four patients developed tethered cord syndrome (TCS) and MRI showed that spinal cones adhered in situ. Spinal expansion exploration, tethered cord, TCS cases did not occur after meningeal repair. Conclusions Spinal canal enlargement exploration, tethering of the tethering cord and meningocele are a reasonable surgical treatment for lumbosacral spinal meningocele. Inaccurate surgical approach is an important cause of TCS after lumbosacral myelomeningocele.