Department of Paediatric Neurosurgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
Singapore Med J. 2012 Sep;53(9):570-6.
Anorectal malformations (ARMs) and low-lying spinal cord (LLC) are commonly associated owing to their common embryonic origin. LLC may lead to tethered cord syndromes (TCS), requiring surgery. This study aimed to review the incidence of LLC in children with ARMs using ultrasonography (US) and magnetic resonance (MR) imaging, the incidence of TCS and the surgical outcomes of these patients after detethering.
We conducted a retrospective study of children who underwent surgery for ARMs in 2002-2009 at KK Women's and Children's Hospital, Singapore.
Out of 101 (16.8%) ARM patients, 17 had LLC, of which 12 (70.6%) were high ARMs. 12 of the 17 (70.6%) patients had abnormal US and MR imaging findings. Five (29.4%) had normal US but abnormal MR imaging results; in these five patients, MR imaging was performed due to new symptoms and equivocal US findings. These 17 patients subsequently underwent surgical detethering. Three out of seven patients with TCS improved after surgery. None of the 17 patients had any complications.
LLC appeared to be associated with high ARMs, although this was not statistically significant. LLC should be investigated for whenever ARM is diagnosed, regardless of its type. Lumbar US is useful for first-line screening for LLC. Abnormal US or onset of new symptoms should subsequently be investigated with MR imaging. Equivocal US findings are also likely to benefit from further MR imaging. Surgery to detether LLC can improve outcome in TCS, while prophylactic detethering for asymptomatic patients with lipoma of the filum terminale has very low surgical risk.
肛门直肠畸形（ARM）和低位脊髓（LLC）通常是相关的，因为它们具有共同的胚胎起源。LLC 可能导致脊髓栓系综合征（TCS），需要手术治疗。本研究旨在通过超声（US）和磁共振（MR）成像来回顾 ARM 患儿 LLC 的发生率、TCS 的发生率以及这些患者在松解后的手术结果。
我们对 2002 年至 2009 年在新加坡 KK 妇女儿童医院接受 ARM 手术的儿童进行了回顾性研究。
在 101 例（16.8%）ARM 患者中，有 17 例存在 LLC，其中 12 例（70.6%）为高位 ARM。17 例 LLC 患儿中，12 例 US 和 MR 成像检查结果异常。5 例（29.4%）US 正常但 MR 成像结果异常；在这 5 例患者中，由于新出现的症状和 US 检查结果不确定，进行了 MR 成像检查。这 17 例患者随后接受了手术松解。7 例 TCS 患者中有 3 例术后症状改善。17 例患者均无并发症。
尽管 LLC 似乎与高位 ARM 相关，但无统计学意义。无论其类型如何，ARM 诊断后均应调查 LLC 的情况。腰椎 US 是 LLC 一线筛查的有用方法。异常 US 或出现新症状后，应进一步行 MR 成像检查。对 US 检查结果不确定的患者，也可能受益于进一步的 MR 成像检查。松解 LLC 以治疗 TCS 可以改善预后，而对无症状终丝脂肪瘤患者进行预防性松解手术的手术风险非常低。
