Tubbs R Shane, Chambers M Renee, Smyth Matthew D, Bartolucci Alfred A, Bruner Joseph P, Tulipan Noel, Oakes W Jerry
Department of Cell Biology, University of Alabama at Birmingham, USA.
Pediatr Neurosurg. 2003 Mar;38(3):128-32. doi: 10.1159/000068818.
To determine whether intrauterine myelomeningocele repair performed at between 20 and 28 weeks gestation improves lower extremity function (LEF).
Thirty-seven consecutive patients who had undergone intrauterine repair of their myelomeningocele at Vanderbilt University Medical Center had their lower extremity function and radiographic level (first defective vertebral level) compared to these same parameters in 40 controls who had undergone traditional postgestational repair of their myelomeningocele at the Children's Hospital in Birmingham, Ala., USA.
Of all 77 patients (controls and study group), 13 had a LEF that matched their radiographic level, 27 had a LEF that was rostral to their radiographic level, and 37 had a LEF that was caudal to their radiographic level. Further stratification revealed that for the intrauterine repaired myelomeningoceles, 11% had no difference between LEF and radiographic level, 43% had a LEF that was rostral to their radiographic level, and 46% had a LEF that was caudal to their radiographic level. For those closed in a traditional manner, LEF matched their radiographic level, was rostral to their radiographic level, and was caudal to their radiographic level in 22.5%, 27.5%, and 50% respectively. However, the overall mean differences between institutions produced a p-value of 0.2026 (paired t-test).
Although the current timing of intrauterine myelomeningocele repair has been found to lessen the degree of herniation of the rhombencephalon and reduce the incidence of shunt-dependent hydrocephalus, it does not statistically improve LEF. Parents should be advised of these findings prior to surgical intervention so as to focus their expectations.
确定在妊娠20至28周进行的宫内脊髓脊膜膨出修补术是否能改善下肢功能（LEF）。
连续37例在范德比尔特大学医学中心接受宫内脊髓脊膜膨出修补术的患者，将其下肢功能和影像学水平（首个椎体缺陷水平）与40例在美国阿拉巴马州伯明翰儿童医院接受传统产后脊髓脊膜膨出修补术的对照组患者的相同参数进行比较。
在所有77例患者（对照组和研究组）中，13例患者的下肢功能与影像学水平相符，27例患者的下肢功能高于其影像学水平，37例患者的下肢功能低于其影像学水平。进一步分层显示，对于宫内修补的脊髓脊膜膨出，11%的患者下肢功能与影像学水平无差异，43%的患者下肢功能高于其影像学水平，46%的患者下肢功能低于其影像学水平。对于那些以传统方式闭合的患者，下肢功能与影像学水平相符、高于其影像学水平、低于其影像学水平的比例分别为22.5%、27.5%和50%。然而，机构间的总体平均差异产生的p值为0.2026（配对t检验）。
尽管目前已发现宫内脊髓脊膜膨出修补术的时机可减轻菱脑疝的程度并降低分流依赖性脑积水的发生率，但在统计学上并未改善下肢功能。在手术干预前，应将这些结果告知家长，以便他们调整期望。
