Martino A, Lomiento D
Divisione di Chirurgia Pediatrica, Ospedale del Bambini G. Salesi, Ancona, Italia.
Pediatr Med Chir. 1987 Mar-Apr;9(2):243-6.
The diagnostic and therapeutic aspects of a pediatric case of tethered cord syndrome are described. The urological symptoms were of primary importance; bladder dysfunction was confirmed urodynamically; voiding cystourethrography showed trabeculation and elongation of bladder with distal sphincter obstruction and left vesicoureteral reflux. The bladder dysfunction was managed satisfactorily with pharmacological therapy and clean intermittent self-catheterization. Nuclear magnetic resonance demonstrated a tethered spinal cord with lipoma of cauda equina. The importance of neuroradiology is emphasized in order to establish an early and precise diagnosis. Early neurosurgery is justified by the need to avoid any progressive and severe lower extremity deficit and by the high frequency of urological improvement in cases treated with spinal operation. However, in this case, clinical and pathological findings suggested to defer any surgical intervention.
本文描述了一例小儿脊髓栓系综合征的诊断与治疗情况。泌尿系统症状最为重要；通过尿动力学检查证实存在膀胱功能障碍；排尿性膀胱尿道造影显示膀胱小梁形成、延长，伴有远端括约肌梗阻及左侧膀胱输尿管反流。采用药物治疗及间歇性清洁导尿，膀胱功能障碍得到了满意的处理。核磁共振显示脊髓栓系合并马尾脂肪瘤。强调了神经放射学对于早期精确诊断的重要性。鉴于需要避免任何进行性严重下肢功能缺损以及脊髓手术治疗病例中泌尿系统功能改善的高发生率，早期神经外科手术是合理的。然而，在本病例中，临床和病理检查结果提示推迟任何手术干预。
