| 摘要: |
| 目的 探讨脊柱均匀短缩脊髓轴性减压术（HSAD）对脊髓栓系综合征（TCS）合并脊柱侧凸的治疗效果。方法 回顾性纳入2015年4月至2018年1月在海军军医大学（第二军医大学）长征医院骨科因TCS合并脊柱侧凸行HSAD治疗的6例患者，记录手术时间、术中失血量、并发症等资料。并于术前、术后行尿动力学检查评估逼尿肌反射、括约肌功能、功能膀胱容量和最大尿流率。结果 男3例、女3例，年龄为7~23岁，平均年龄为（15.7±6.9）岁，平均随访时间为（28±9）个月。其中5例患者伴大小便失禁，3例伴足下垂，4例伴下肢肌力下降，1例存在腰痛，1例合并髋关节脱位。6例患者手术时间为180~320 min，平均（261±63）min；术中失血量为650~1 100 mL，平均（925±167）mL。1例腰痛患者术后腰痛症状完全缓解，4例伴下肢肌力下降患者术后下肢肌力均有改善。1例患者因术后未行尿动力学检查未予统计；其余5例患者于术前、术后均接受尿动力学检查，其中4例术前尿道外括约肌过动、1例失调，术后2例尿道外括约肌协调、1例改善、2例过动。术前、术后功能膀胱容量分别为195.0（127.5，233.5）mL、213.0（188.5，251.5）mL，差异无统计学意义（Z=-0.4，P=0.70）。术前最大尿流率、残余尿量分别为7.3（1.4，10.3）mL/s、130（106，200）mL，与术后[10.3（5.6，16.2）mL/s、30（6，174）mL]相比差异均有统计学意义（Z均=-2.0，P均=0.04）。5例患者术后膀胱逼尿肌肌力得到不同程度改善，最大尿流率增加，残余尿减少。结论 TCS合并脊柱侧凸可以通过HSAD一期手术治疗，该手术可同时缓解脊髓轴向张力、矫正脊柱畸形、恢复脊柱和脊髓的协调性。患者术后下肢症状和膀胱功能均得以有效改善，同时避免了脑脊液漏、出血多和神经功能恶化等并发症。 |
| 关键词: 脊髓栓系综合征 脊柱侧凸 脊柱均匀短缩 脊髓轴性减压术 |
| DOI：10.16781/j.0258-879x.2020.03.0266 |
| 投稿时间：2019-12-12修订日期：2020-02-13 |
| 基金项目:国家自然科学基金（81871828，81702141）. |
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| Homogeneous spinal-shortening axial decompression in treatment of tethered cord syndrome combined with scoliosis: a therapeutic effect analysis |
| XU Xi-ming,SUN Jing-chuan,WANG Yuan,SUN Kai-qiang,ZHU Jian,KONG Qing-jie,GUO Yong-fei,SHI Guo-dong,SHI Jian-gang* |
(Department of Orthopaedics, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To explore the therapeutic effect of homogeneous spinal-shortening axial decompression (HSAD) in patients with tethered cord syndrome (TCS) and scoliosis. Methods Six patients with TCS and scoliosis, who underwent HSAD in Orthopaedics Department of Changzheng Hospital of Naval Medical University (Second Military Medical University) from Apr. 2015 to Jan. 2018, were retrospectively included. The operation time, intraoperative blood loss and complications were recorded. Urodynamic examination was performed to evaluate the bladder function before and after surgery, including detrusor reflex, sphincter function, functional bladder capacity and maximal urination speed. Results There were three males and three females, aged 7-23 (mean 15.7±6.9) years old, with an average follow-up of (28±9) months. Five patients had incontinence, three had foot-drop, four had decreased lower limb muscle strength, one had low back pain, and one had congenital dislocation of the hip. The operation time was 180-320 min (mean[261±63]min), and the intraoperative blood loss was 650-1 100 mL (mean[925±167]mL). After surgery, the low back pain was completely relieved in one patient, and the muscle strengths of the lower extremities were improved in four patients. Five patients received urodynamic examination before and after surgery. Before surgery, four cases were evaluated as external sphincter overactivity and one case as uncoordinated sphincter activity; after surgery, two cases were evaluated as normal external sphincter activity, one case as coordinated external sphincter activity, and two cases as external sphincter overactivity. The functional bladder capacity of the five patients was 195.0 (127.5, 233.5) mL and 213.0 (188.5, 251.5) mL before and after surgery, respectively, and the difference was not significant (Z=-0.4, P=0.70). The maximal urination speed and residual urine before surgery were 7.3 (1.4, 10.3) mL/s and 130 (106, 200) mL, respectively, and were significantly different from those after surgery (10.3[5.6, 16.2]mL/s and 30[6, 174]mL, respectively; both Z=-2.0, both P=0.04). In the five patients, the bladder detrusor muscle strength was improved to different extents, the maximal urination speed was increased, and the residual urine was reduced. Conclusion HSAD is an effective one-stage technique to relieve the TCS combined with scoliosis, and it can effectively relieve the axial tension of the spinal cord, correct the deformity of the spine and improve the coordination between spine and spinal cord. The lower limb symptoms and bladder function are improved after surgery, and complications such as cerebrospinal fluid leakage, bleeding, and deterioration of neurological function are avoided. |
| Key words: tethered cord syndrome scoliosis homogeneous spinal-shortening spinal axial decompression |
