摘要：目的 探讨儿童脊髓脂肪瘤手术年龄、病理解剖类型与愈后关系。方法 回顾性分析211例儿童脊髓脂肪瘤的临床资料，以手术年龄、手术前后直肠膀胱功能评分和运动功能评价、术中解剖分型、脊髓松解程度进行综合评估。结果 除髓内型外，各病理解剖类型组中，术前不同膀胱直肠功能评分的平均年龄之间具有显著差异（P＜0.05）。手术能保持原有正常功能，术后直肠膀胱功能总体改善率48.3%、加重率0.97%，运动改善率43.2%、加重率0.96%。依脊髓松解程度分为可分离型和不可分离型，复合型42例（100%）和膨出型13例（32.5%）为不可分离型。结论 患儿症状随年龄增长加重，说明早期手术必要性，手术具有稳定和改善症状作用，对不可分离型不可盲目再次手术。

关键词： 脊髓脂肪瘤；解剖分型；显微技术；功能评分；

中图分类号：R726.2

The clinical classification and curative evaluation in children with spinal lipomas

Lian-ping SUN , Hui-ming JIN , Bo YANG , Yan WU , Jie MA

Department of pediatric neurosurgery ,Xinhua Hospital,School of Medicine, Shanghai Jiaotong University ,Shanghai 200092, China

Abstract:  Objecctive  To discuss the relationship between the operating age, anatomical type and pregnosis in children with spinal lipoma.   Methods The clinical data of 211 cases with spinal lipoma were given the overall assessment based on age, functional scores of the bladder and anal sphincter, movement, anatomical classification and extent of untethering in surgery , retrospectively.Results There are significant differences (P<0.05) between the average ages of patients with various scores in each type except intramedullar type pre-operation . The surgical interferences can preserve normal primary functions and not only give the total improvement rate in 48.3% to sphincters and in 43.2% to movements but the deterioration rate in 0.97% and 0.96% respectively as well.   According to the extent of untethering , all patients can be divided into separable type and inseparable type which is the combined type in 42 cases(100%) and the lipomyelomeningocele  in 13( 32.5%). Conclusion  The neurological deteriorations are related to the increasing age, which indicates that the surgery intervention  should be done as early as possible. The surgical interferences can stabilize and improve the symptoms and would be unnecessary  in inseparable type if cord presents tethered again.

Keywords:  spinal lipomas, anatomical types, Microtechnique ，functional scale

发表于：2009-01-11 23:18