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妊娠期多发性胎儿发育异常一例
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Abstract:
近年来,随着医学水平的不断提高,胎儿宫内发育异常及出生缺陷患儿的检出率也有所升高,人们对优生优育也有了新的追求与目标。作为胎儿发育异常其中的一种疾病,脊髓栓系综合(Tethered cord syndrome, TCS)也逐渐出现在人们的视野当中。脊髓栓系综合征是指先天或者后天因素导致脊髓受到牵拉、压迫、圆锥低位,造成脊髓神经血管出现缺血、缺氧,逐渐发生变性或退行性改变,临床上出现下肢感觉、运动功能障碍或畸形、大小便功能障碍等神经损害的症候群。因为下肢神经受损而引起的运动障碍有可能会影响患者的正常社交和生活,对患者造成心理和躯体痛苦。目前,TCS多通过影像学检查及临床表现来诊断,儿童及成人的TCS大多采取手术治疗,且手术治疗后,多数患者症状有不同程度改善。国内关于此病报道较少,本文对1例患有脊髓拴系综合症的胎儿临床资料进行总结分析,并结合文献探讨TCS的发病机制、临床症状、诊疗方法,旨在提高临床医务工作者对TCS的认识,减少出生缺陷儿的出生率。
In recent years, with the continuous improvement of the medical level, the detection rate of fetal intrauterine growth abnormalities and birth defects in children has also increased, and people have a new pursuit and goal for eugenics and eugenics. Tethered cord syndrome (TCS), one of the disor-ders of fetal development, has gradually emerged in our field of vision. Tethered cord syndrome (TCS) refers to congenital or acquired factors that cause the spinal cord to be stretched, compressed, and conus low, resulting in ischemia and hypoxia of spinal nerves and blood vessels. Degeneration or degenerative changes occur gradually, and the symptoms of nerve damage such as sensory and motor dysfunction or deformity of lower limbs and dysfunction of bowel and bladder appear clini-cally. Dyskinesia caused by lower limb nerve damage may affect the normal social and life of pa-tients, causing psychological and physical pain to patients. At present, TCS is diagnosed by imaging examination and clinical manifestation. Most of children and adults are treated by surgery, and most patients have different degree of improvement after surgery. There are few reports about this disease in China. This article summarizes and analyzes the clinical data of a fetus with tethered cord syndrome, and combined with the literature, explores the pathogenesis of TCS, clinical symptoms, diagnosis and treatment methods, in order to improve the clinical medical workers to TCS under-standing, reduce birth defects birth rate.
[1] | Paladini, D., Malinger, G., Birnbaum, R., et al. (2021) ISUOG Practice Guidelines (Updated): Sonographic Examination of the Fetal Central Nervous System. Part 2: Performance of Targeted Neurosonography. Ultrasound in Obstetrics & Gynecology, 57, 661-671. https://doi.org/10.1002/uog.23616 |
[2] | Agarwalla, P., Dunn, I., Scott, R., et al. (2007) Tethered Cord Syndrome. Neurosurgery Clinics of North America, 18, 531-547. https://doi.org/10.1016/j.nec.2007.04.001 |
[3] | B?chli, H., Wasner, M. and Hefti, F. (2002) Intraspinal Malfor-mations. Tethered Cord Syndrome. Orthopade, 31, 44-50.
https://doi.org/10.1007/s132-002-8273-8 |
[4] | Hertzler, D., Depowell, J., Stevenson, C., et al. (2010) Tethered Cord Syndrome: A Review of the Literature from Embryology to Adult Presentation. Neurosurgical Focus, 29, E1. https://doi.org/10.3171/2010.3.FOCUS1079 |
[5] | Cabraja, M., Thomale, U. and Vajkoczy, P. (2008) Spinal Dis-orders and Associated CNS Anomalies-Tethered Cord and Arnold-Chiari Malformation. Orthopade, 37, 347-355. https://doi.org/10.1007/s00132-008-1232-6 |
[6] | Solmaz, I., Izci, Y., Albayrak, B., et al. (2011) Tethered Cord Syndrome in Childhood: Special Emphasis on the Surgical Technique and Review of the Literature with Our Experience. Turkish Neurosurgery, 21, 516-521.
https://doi.org/10.5137/1019-5149.JTN.4394-11.1 |
[7] | Apaydin, M.J.S. and Sra, R.A. (2020) Tethered Cord Syn-drome and Transitional Vertebrae. Surgical and Radiologic Anatomy, 42, 111-119. https://doi.org/10.1007/s00276-019-02341-5 |
[8] | Lew, S. and Kothbauer, K. (2007) Tethered Cord Syndrome: An Updated Review. Pediatric Neurosurgery, 43, 236-248. https://doi.org/10.1159/000098836 |
[9] | Tu, A. and Stein-bok, P. (2013) Occult Tethered Cord Syndrome: A Review. Child’s Nervous System, 29, 1635-1640.
https://doi.org/10.1007/s00381-013-2129-1 |
[10] | Hode, L., Noukpozounkou, S., Avakoudjo, J., et al. (2019) Teth-ered Cord Syndrome in Children: About a Case. The Pan African Medical Journal, 34, 151. https://doi.org/10.11604/pamj.2019.34.151.18344 |
[11] | Kriss, V., Kriss, T., Desai, N., et al. (1995) Occult Spinal Dysraphism in the Infant. Clinical Pediatrics, 34, 650-654.
https://doi.org/10.1177/000992289503401205 |
[12] | Aldave, G., Hansen, D., Hwang, S., et al. (2017) Spinal Col-umn Shortening for Tethered Cord Syndrome Associated with Myelomeningocele, Lumbosacral Lipoma, and Lipomye-lomeningocele in Children and Young Adults. Journal of Neurosurgery: Pediatrics, 19, 703-710. https://doi.org/10.3171/2017.1.PEDS16533 |
[13] | Edstr?m, E., Wesslé, N.C., Fletcher-Sandersj??, A., et al. (2022) Filum Terminale Transection in Pediatric Tethered Cord Syndrome: A Single Center, Population-Based, Cohort Study of 95 Cases. Acta Neurochirurgica, 164, 1473-1480.
https://doi.org/10.1007/s00701-022-05218-6 |
[14] | Fekete, G. and Bognár, L. (2019) Surgical Treatment of Tethered Cord Syndrome-Comparing the Results of Surgeries with and without Electrophysiological Monitoring. Child’s Nervous System, 35, 979-984.
https://doi.org/10.1007/s00381-019-04129-9 |
[15] | Selcuki, M., Mete, M., Barutcuoglu, M., et al. (2015) Tethered Cord Syndrome in Adults: Experience of 56 Patients. Turkish Neurosurgery, 25, 922-929. https://doi.org/10.5137/1019-5149.JTN.11700-14.1 |
[16] | 宋风荣. 彩超检测胎儿颈项透明层厚度在早孕期筛查胎儿畸形的价值思考[J]. 健康大视野, 2019(11): 35. |
[17] | Nafziger, E. and Vilensky, J. (2014) The Anatomy of Nu-chal Translucency at 10-14 Weeks Gestation in Fetuses with Trisomy 21: An Incredible Medical Mystery. Clinical Anatomy, 27, 353-359. https://doi.org/10.1002/ca.22376 |
[18] | Kobets, A., Oliver, J., Cohen, A., et al. (2021) Split Cord Malformation and Tethered Cord Syndrome: Case Series with Long-Term Follow-Up and Literature Review. Child’s Nervous System, 37, 1301-1306.
https://doi.org/10.1007/s00381-020-04978-9 |
[19] | Horn, S., Moses, M., Vasquez-Montes, D., et al. (2020) Teth-ered Cord Syndrome in the United States Cluster Analysis of Presenting Anomalies and Associated. Bulletin of the Hos-pital for Joint Diseases, 78, 157-162. |