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1、小儿脊髓纵裂及其合并畸形治疗作者：刘福云，夏冰，司丕成，郭永成【关键词】脊髓纵裂；脊髓栓系；脊柱侧弯；手术摘要：［目的］探讨小儿脊髓纵裂及其合并畸形的治疗方法。［方法］回顾性分析近10a获随访经手术治疗的脊髓纵裂患儿48例，男29例，女19例；年龄7旷14岁。均因腰背部异常、双下肢和（或）二便功能障碍做全脊柱X线、MRI、CT等检查。手术先切断终丝松解栓系，再打开硬膜直视下切除纤维束或骨软骨靖，合并先天性脊柱侧弯者一期或二期半脊椎后路切除矫形。［结果］48例患儿均有脊髓低位,伴发脊髓栓系综合征34例，脊柱侧弯及后凸26例，脊髓脊膜膨出14例，脊髓空洞15例，椎管内脂肪
2、瘤12例。依照脊髓纵裂Pang分型：I型27例，II型18例，混合型3例。位于颈段1例，胸段6例，胸腰段1例，腰段38例，紙段2例。术后改善28例，恢复正常3例，无效3例。后路半脊椎切除术矫治先天性脊柱侧弯效果满意。［结论］脊髓纵裂极易合并脊髓栓系及先天性脊柱侧弯，患儿应常规行脊柱X线、MRI、CT等检查，以提高脊髓纵裂、脊髓栓系及其他脊柱畸形的诊断率。早期切断终丝松解栓系，直视下切除纤维性、骨或软骨性间隔是治疗脊髓纵裂的必要手段。同时一期或二期后路半脊椎切除是早期治疗先天性脊柱侧弯的有效方法。关键词：脊髓纵裂；脊髓栓系；脊柱侧弯；手术Abstract:[Object
3、ive]Toanalyzeclinicalfeatures,evaluatediagnosticproceduresanddiscussthedifferentformsoftherapyforeachcaseofsplitcordma1formation(SCM)[Method]Aseriesof48patientshadafollowupperiodof05~9years,29malesand19females,aged7daysto14years,wereevaluatedretrospectivelyTheysufferedfrombackmidlineabn
4、ormalities,neurologicaldeficitsoflowerlimbsandbladderdysfunctionAtfirsttheywerecutfilumterminaleandthenexcisedthefibrousorbonyspurfinallytreatedscoliosisTheradiologiealproceduresusedforthediagnosisofSCMwerespinalXray,ultrasound,CTscanandMRI[Result]Inallofthe48patientswithtetheredcord,th
5、erewere28caseswithdysplasiaoflowerlimbsandfeet,13caseswithurinationanddefecationdysfunction,14caseswithonlydorsallumbarabnormalities,26caseswithscoliosisandkyphosis,14withmyelomeningocele,15withsyringomyeliaand12withintraspinallipomasTherewere27casessufferingfromtypeISCM,18typeIISCMand3
6、compositetypeSCMaccordingtoPangThemostfrequentlocationofthespurwasatthelumbarlevel(38cases),thelessfrequentinthoracicregions(6cases)andexceptionallyrarebelowSI(2cases),inthecervicalregions(1case),thethoralumbar(1case)Afteroperation,28caseswereimproved,3caseswerecuredand3caseswereineffic
7、acy[Conclusion]ThemostfrequentsyndromeofSCMpatientsislowerlimbsdysplasiaanddorsallumbarabnormalitiesThepatientsaremostsufferedfromtetheredcordandspinaldeformitiesToimprovediagnosisofSCM,tetheredcordandotherdeformities,thepatientsshouldberoutinelyevaluatedbyMRIandXrayofthewholes
