儿童单纯脊髓栓系综合征小切口松解术的安全性及有效性分析

Safety and efficacy analysis of minimally invasive tethered cord release for children with tethered cord syndrome alone

摘要:

目的 探讨儿童单纯脊髓栓系综合征（TSC）小切口松解术的安全性及有效性。方法 选取2017年12月—2020年12月宁波大学医学院附属医院收治的82例单纯TSC患儿，将其随机分为对照组和观察组，各41例。所有患儿仅采用终丝切断术，其中对照组患儿采用传统手术，观察组患儿采用小切口松解术，并术后随访6个月。比较两组患儿住院时间、切口大小；术后及随访终点的临床疗效；手术前后及随访6个月的视觉模拟评分（VAS）、日本骨科协会评估量表（JOA）评分变化；术后并发症。结果 观察组患儿住院时间短于对照组（P <0.05），切口小于对照组（P <0.05）。术后和随访6个月时，两组患儿的总有效率比较，差异无统计学意义（P >0.05）。观察组与对照组患儿术前、术后、随访6个月的VAS、JOA评分比较，采用重复测量设计的方差分析，结果 ①不同时间点的VAS、JOA评分有差异（F =2.507和4.142，P =0.014和0.000）；②观察组与对照组VAS、JOA评分有差异（F =4.913和2.229，P =0.000和0.029）；③两组VAS、JOA评分变化趋势有差异（F =35.944和167.373，均P =0.000）。观察组患儿术后并发症总发生率低于对照组（P <0.05）。结论 小切口松解术治疗儿童单纯TSC疗效显著，可缩短住院时间，有效缓解疼痛，改善腰椎功能，且安全性良好。

Abstract:

Objective To investigate the safety and efficacy of minimally invasive tethered cord release in the treatment of children with tethered cord syndrome (TSC) alone.Methods A total of 82 children with TSC alone treated in our hospital from December 2017 to December 2020 were randomly divided into control group (n = 41) and observation group (n = 41). All children were treated with resection of the filum terminale only. The children in the control group were treated with traditional surgery, while the children in the observation group were treated with minimally invasive surgery. The children were followed up for 6 months after operation. The length of hospital stay, the incision size, the clinical efficacy right after operation and at the end of follow-up, changes of visual analogue scale (VAS) score and Japanese Orthopaedic Association scale (JOA) score before and after operation and after 6 months of follow-up, and postoperative complications were compared between the two groups.Results The length of hospital stay of the observation group was shorter than that of the control group (P < 0.05), and the incision size of the observation group was smaller than that of the control group (P < 0.05). There was no significant difference in the overall effective rate between the two groups after operation and at 6-month follow-up (P > 0.05). The VAS and JOA scores of the observation group and the control group were compared before operation, after operation, and after 6 months of follow-up, using repeated measures analysis of variance. The results revealed that there were differences in the VAS and JOA scores at different time points (F = 2.507 and 4.142, P = 0.014 and 0.000) and between the observation group and the control group (F = 4.913 and 2.229, P = 0.000 and 0.029), and that there were differences in the change trend of VAS and JOA scores between the two groups (F = 35.944, 144.192, 126.034 and 167.373, all P = 0.000). The overall incidence of postoperative complications in the observation group was lower than that in the control group (P < 0.05).Conclusions Minimally invasive tethered cord release exhibits great efficacy in the treatment of children with TSC alone. Specifically, it can shorten the length of hospital stay, relieve pain and improve the function of lumbar spine effectively and safely.