Nejat Farideh, Kazmi Syed Shuja, Habibi Zohreh, Tajik Parvin, Shahrivar Zahra
Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.
J Neurosurg. 2007 Feb;106(2 Suppl):106-10. doi: 10.3171/ped.2007.106.2.106.
Meningomyelocele (MMC) is a common central nervous system birth defect. As one of many problems facing patients with MMC, learning disabilities are often overlooked. The aim of this study was to evaluate IQs in a group of children with MMCs and determine if a correlation exists between intelligence level and the presence of an MMC and/or its complications.
A case-control study was conducted at the Children's Hospital Medical Center in Tehran, Iran, from December 2004 through December 2005. The patient group included 50 children with MMC from 5 to 12 years of age who were referred to the authors' institution for treatment of complications or for follow up after surgery for MMC closure. The patient group was individually matched for age and sex with a control group of 50 children referred to the hospital for other reasons and who did not have MMC or other neurological abnormalities. The IQs in all children in this study were evaluated using the Ravens Progressive Matrices test. The children in both groups were similar in the socioeconomic status of the family (p = 0.347) and educational status of the father (p = 0.117) and mother (p = 0.439). Patient age at the time of surgery for MMC closure varied from 1 day to 96 months (mean 4.1 months). Only 20% of the patients with MMC could walk with a normal gait. Forty-six percent of the patients had undergone placement of a ventriculoperitoneal shunt, and half of these patients experienced shunt-related complications; 72% of the children in the patient group were completely incontinent for both urine and feces. The IQ results obtained in the patient group ranged from 73 to 134 with a mean (+/- standard deviation) of 96.62 +/- 13.01. In the control group the IQ range was 70 to 128, and the mean was 104.82 +/- 12.30. Compared with the control group there was a statistically significant correlation between having an MMC and having a lower IQ (p < 0.001, paired t-test).
Although the average IQ in the patient group was significantly lower than that in the control group, it is important to note that all children in the patient group had an average or above-average IQ. In contrast with the results reported in other studies, earlier repair of the MMC, the presence of a shunt or shunt-related complications, walking difficulty, and the spinal level of the lesion did not correlate significantly with IQs. Therefore, the lower IQ and reduced cognitive levels noted in these patients result from the disease process itself and not from the associated complications.
脊髓脊膜膨出（MMC）是一种常见的中枢神经系统出生缺陷。作为MMC患者面临的诸多问题之一，学习障碍常常被忽视。本研究的目的是评估一组患有MMC的儿童的智商，并确定智力水平与MMC的存在和/或其并发症之间是否存在相关性。
2004年12月至2005年12月在伊朗德黑兰的儿童医院医学中心进行了一项病例对照研究。患者组包括50名年龄在5至12岁之间的患有MMC的儿童，他们因并发症治疗或MMC闭合手术后的随访被转诊至作者所在机构。患者组在年龄和性别上与50名因其他原因转诊至该医院且无MMC或其他神经异常的儿童对照组进行个体匹配。本研究中所有儿童的智商均使用瑞文渐进矩阵测验进行评估。两组儿童在家庭社会经济状况（p = 0.347）、父亲教育状况（p = 0.117）和母亲教育状况（p = 0.439）方面相似。MMC闭合手术时患者的年龄从1天到96个月不等（平均4.1个月）。只有20%的MMC患者能够正常步态行走。46%的患者接受了脑室腹腔分流术，其中一半患者经历了与分流相关的并发症；患者组中72%的儿童大小便完全失禁。患者组获得的智商结果范围为73至134，平均（±标准差）为96.62±13.01。对照组的智商范围为70至128，平均为104.82±12.30。与对照组相比，患有MMC与较低智商之间存在统计学上的显著相关性（p < 0.001，配对t检验）。
虽然患者组的平均智商显著低于对照组，但需要注意的是，患者组中的所有儿童智商均处于平均水平或高于平均水平。与其他研究报告的结果相反，MMC的早期修复、分流管的存在或与分流相关的并发症、行走困难以及病变的脊髓节段与智商均无显著相关性。因此，这些患者中智商较低和认知水平下降是由疾病过程本身导致的，而非相关并发症所致。
