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目的了解脊髓栓系综合征(TCS)手术治疗的常见并发症,探讨其发生机制和处理措施,以指导手术。方法对2006年2月-2007年10月郑州大学第三附属医院收治的313例TCS患儿在显微操作下行脊髓探查松解术。对脊髓外翻、脊膜膨出破损患儿入院即予抗生素治疗。按年龄分为A组(1 d～3个月)82例、B组(>3个月～3岁)104例、C组(>3～7岁)60例、D组(>7～14岁)67例;按病理类型分为E组(椎管内脂肪瘤)77例、F组(椎管内囊肿)39例、G组(单纯脊髓栓系)113例、H组(脊膜膨出修补术后)84例。术后随访8～30个月,总结分析各组手术并发症发生情况,采用SPSS 10.0软件进行统计学处理。结果TCS手术并发症主要有下肢疼痛/腹胀(62例,19.8%)、排尿异常(65例,20.8%)、颅压升高(26例,8.3%)、脑脊液漏(18例,5.8%)、神经损伤(12例,3.8%)、术后黏连(13例,4.2%)等。另有2例(0.64%)因脑膜炎死亡,5例(1.6%)出现浅表褥疮。排尿异常、颅压升高、神经损伤、术后黏连在不同年龄组中的发生率均有显著差异(Pa<0.05);不同病理类型组中,G组神经损伤和术后黏连发生率相对较低。结论早期诊断和术中显微操作是治疗TCS的关键;新生儿和单纯脊髓栓系患儿术后并发症少;脊髓外翻、脊髓脊膜膨出破损患儿术前应用抗生素、营养支持能降低脑膜炎的发生。
Objective To understand the common complications of surgical treatment of tethered cord syndrome (TCS) and to explore its mechanism and treatment measures to guide the operation. Methods From February 2006 to October 2007, 313 cases of children with TCS admitted to the Third Affiliated Hospital of Zhengzhou University underwent microsurgical exploration of spinal cord exploration. On the spinal cord valgus, children with adduction of spinal meningitis is antibiotic treatment. There were 82 cases in group A (1 d ~ 3 months), 104 cases in group B (> 3 months to 3 years old), 60 cases in group C (> 3 to 7 years old), and group D (> 7 to 14 Year old), 67 cases were divided into group E (intraspinal lipoma) 77 cases, group F (intraspinal canal cyst) 39 cases, group G (simple tethered cord) 113 cases, group H After repair surgery) 84 cases. The patients were followed up for 8 to 30 months. The incidence of surgical complications in each group was analyzed. The data were analyzed by SPSS 10.0 software. Results The main complications of TCS were lower extremity pain and abdominal distension (62 cases, 19.8%), abnormal voiding (65 cases, 20.8%), elevated intracranial pressure (26 cases, 8.3% , Nerve injury (12 cases, 3.8%), postoperative adhesions (13 cases, 4.2%) and so on. In 2 cases (0.64%) died of meningitis, superficial bedsores occurred in 5 cases (1.6%). The incidence of abnormal urination, intracranial pressure, nerve injury and postoperative adhesions in different age groups were significantly different (P <0.05). Among the different pathological types, the incidence of nerve injury and postoperative adhesion relatively low. Conclusions Early diagnosis and intraoperative microsurgery are the key to the treatment of TCS. There are few postoperative complications in newborns and patients with simple tethered cord. Patients with spinal eversion and meduplex meningitis before operation need antibiotics, nutritional support Reduce the incidence of meningitis.