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目的评价先天性神经管畸形(CNTD)超早期显微外科治疗的效果。方法 2004年6月-2009年1月本院收治的56例CNTD患儿均行神经系统检查和MRI检查,随后行显微外科手术治疗。手术方法:麻醉成功后,取俯卧位沿脊柱后正中切口,打开骨性椎管暴露硬脊膜,脑膜剪剪开硬膜,在神经电生理的配合下分离出马尾神经,松解脊髓圆锥,再游离终丝,最后完整修补缺损硬脊膜,选择性切断增粗变短的终丝,以达到解除脊髓栓系、降低脊髓张力的目的。术后疗效按治愈、好转、无变化和加重进行评定。结果按Kirollos术中松解分级评定方法,53例(94.6%)达到1级全部松解,2例(3.5%)达到2级部分松解,1例(1.8%)为3级未松解。手术近期疗效:治愈15例(27%),排便、排尿等功能恢复正常;好转32例(57%),排尿、排便功能及下肢肌力有一项明显改善;无变化9例(16%),与术前症状一致;无恶化病例。结论超早期显微外科手术是治疗CNTD的有效方法。
Objective To evaluate the effect of ultra-early microsurgery treatment of congenital neural tube defects (CNTD). Methods From June 2004 to January 2009, 56 children with CNTD admitted to our hospital underwent neurological examination and MRI examination, followed by microsurgery. Surgical methods: After the success of anesthesia, take the prone position along the posterior midline incision, open the bony spinal canal exposed dura mater, cut open the dura mater cutaneous nerve electrophysiology in the separation of cauda equina nerve, release spinal cord cones, And then the free end of the wire, the final complete repair of defects dura mater, selectively cut thickening shorter end of the wire, in order to lift the cord tethered, lower spinal cord tension purposes. Postoperative efficacy by cure, improvement, no change and increase the assessment. Results According to the method of Kirollos intraoperative loosening and grading evaluation, 53 cases (94.6%) reached grade 1 for complete loosening, 2 cases (3.5%) for grade 2 partial loosening and 1 case (1.8%) for grade 3 undissociated. There were 15 cases (27%) cured and the functions of defecation and urination returned to normal in 32 cases (57%). There was a significant improvement in urination, defecation function and lower extremity muscle strength; 9 cases (16% Consistent with the preoperative symptoms; no worsening cases. Conclusion Ultra-early microsurgery is an effective method for the treatment of CNTD.