复杂型脊髓拴系综合征患者的诊治策略

【摘要】目的研究复杂型脊髓拴系综合征患者的临床症状、影像学表现、治疗策略等。方法回顾性分析89例复杂型脊髓拴系综合征患者的临床资料，通过分析造成脊髓拴系的原因，采取不同的手术策略，达到完全松解脊髓拴系的目的，从而探索复杂型脊髓拴系综合征的个体化诊治策略。结果复杂型脊髓拴系综合征中造成脊髓拴系的主要原因包括终丝病理性增粗及脂肪瘤化、蛛网膜粘连包裹、脊髓脊膜膨出（脊膜膨出）、脊髓末端脂肪瘤、脊椎畸形卡压、脊髓纵裂等。复杂型脊髓拴系综合征通常是由三种及三种以上的致栓因素导致，不同患者表现复杂多变，需采取个体化治疗策略。结论复杂型脊髓拴系综合征通常由三种或三种以上致栓因素导致。针对不同的患者采取个体化手术治疗策略，最终才能达到脊髓拴系彻底松解的目的，这才是个体化治疗的意义。

Abstract: ObjectiveTo study the clinical symptoms, imaging manifestations and treatment strategies of patients with complex tethered cord syndrome. MethodsThe clinical data of 89 patients with complex tethered spinal cord syndrome were analyzed retrospectively. By analyzing the causes of tethered spinal cord, different surgical strategies were adopted to completely release the tethered spinal cord, so as to explore the individualized diagnosis and treatment strategy of complex tethered spinal cord syndrome. ResultsThe main causes of complex tethered cord syndrome included pathological thickening and lipomatosis of terminal filaments, arachnoid adhesion, spinal meningeal bulging(meningocele), terminal spinal lipomas, spinal deformity compression, spinal cord split, etc. Complex tethered cord syndrome was usually caused by there or more tetherized factors. Different patients had complex and variable performances, and individual treatment strategies were required. ConclusionsComplex tethered cord syndrome is usually caused by three or more tethering factors. Individualized surgical treatment strategies for different patients can finally achieve the purpose of complete release of spinal cord tether, which is the significance of individualized treatment.