神经电生理监测在儿童脊髓拴系综合征显微外科手术中的应用及意义

Application and significance of neurophysiological monitoring in microsurgery for children with tethered cord syndrome

中文关键词:  脊髓拴系综合征  并发症  电生理监测

英文关键词:Tethered Cord Syndrome  Complication  Electrophysiologic monitoring

中文摘要:

  【摘要】 目的：探讨神经电生理监测在儿童脊髓拴系综合征显微外科手术中应用的意义。方法：回顾性分析2005年～2011年收治的105例小儿脊髓拴系患者的临床资料。所有患者在显微镜辅助下行脊髓探查及拴系松解术，其中49例（2008年后病例）行术中电生理监测（A组），56例未进行电生理监测（B组）。统计两组患者术后并发症发生及治疗情况并进行统计学分析，术后6个月随访了解患者大小便功能、下肢感觉运动功能及神经电生理恢复情况，疗效评定采用Hoffman分级标准，比较两组患者的拴系完全松解（脊髓末端与周围无粘连，术中脊髓末端上升）率及治疗的有效率。结果：105例患者均顺利完成手术，A组患者术后无下肢瘫痪发生，仅出现大小便失禁2例，脑脊液漏4例；而B组患者术后出现下肢瘫痪5例，大小便失禁8例，脑脊液漏8例，发生率均明显高于A组（P<0.05）；术后92例患者得以随访，时间为6个月～5年，平均2.5年，A组手术完全松解37例，松解率为75%，有效率为70%；B组完全松解36例，松解率为64%，与A组相比有显著性差异（P<0.05），有效率为58%，与A组比较也具有显著性差异（P<0.05）。结论：显微外科手术配合神经电生理监测可明显降低儿童脊髓拴系综合征术后并发症，提高拴系完全松解率及改善中短期神经功能恢复情况。

英文摘要:

  【Abstract】 Objectives: To esplore the application and significance of neurophysiological monitoring in microsurgery for children with tethered cord syndrome(TCS). Methods: A retrospective analysis was made on 49(neurophysiological monitoring group, group A) and 56(no neurophysiological monitoring group, group B) children with tethered cord syndrome between 2008 to 2011 and 2005 to 2007 respectively. All cases with TCS underwent microneurosurgical releasing of tethered cord. Posterior tibial nervesomatosensory evoked potential(PTN-SEP) was detected by Vikingquest Electromyogram Evoked Potential Meter during operation. Spinal dura mater was repaired with a-cyanoacrylate alkyl in strengthening. The complications and outcome between 2 groups were compared. 6 months later, the neurological function and physioelectrical function were evaluated, Hoffman criteria was used for evaluating the outcome. Results: All patients′ surgeries were successful. No case in group A presented paraplegia after operation except 2 cauda equine syndrome and 4 CSF leakage; while in group B, paraplegia, cauda equine syndrome and CSF leakage was noted in 5, 8 and 8 cases respectively, which had higher incidence than group A(P<0.05). 92 patients were followed up for 6 months to 5 years, with an average of 2.5 years. 37 cases in group A had complete release of tethered cord with the release rate of 75%(effective rate, 70%); while 36 cases in group B had complete release with the release rate of 64%(effective rate, 58%), which showed significant difference(P<0.05). Conclusions: Microsurgery with electrophysiologic monitoring has less complications as well as improve release rate and neurofunction for pediatric tethered cord syndrome at short-to-middle stage.