Spina bifida outcome: A 25-year prospective
Spina bifida outcome: A 25-year prospective
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DOI：
10.1159/000056005
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发表时间：
2001-03-01
影响因子：
0.7
通讯作者：
Ito, JA
中科院分区：
文献类型：
--
作者：
Bowman, RM;McLone, DG;Ito, JA
背景：开放性脊柱裂是最复杂的先天性畸形，可长期存活。本报告概述了我们最初队列的脊髓脊膜膨出患者在非选择性、前瞻性方式治疗后20- 25年的结果。方法：在最初的118名儿童中，有71名患者可用于我们最近的审查。19名患者失访，28名患者死亡。数据收集于：运动水平、分流状态、教育/就业、癫痫发作史、活动性、膀胱/肠痉挛、脊髓栓系、脊柱侧凸、乳胶过敏、颈椎后路减压、气管造口术和/或胃造口术插管。结果：死亡率（24%）继续攀升到青年期。86%的队列有脑脊液分流，其中95%至少经历过一次分流翻修。32%的患者接受了脊髓栓系松解术，97%的患者术前症状得到改善或稳定。49%的人患有脊柱侧凸，43%的人最终需要脊柱融合。16名患者（23%）至少有一次癫痫发作。85%的人正在就读或已经从高中和/或大学毕业。超过80%的年轻人患有社交膀胱炎。大约1/3的患者对乳胶过敏，其中6例患者发生了危及生命的反应。结论：至少有75%的脊髓脊膜膨出患儿可以活到成年早期。晚期恶化是常见的。当今医学界最大的挑战之一是为这些患有脊柱裂的成年人建立一个护理网络。版权所有（C）2001 S. Karger AG，巴塞尔。
Background: Open spina bifida is the most complex congenital abnormality compatible with long-term survival. This report outlines the 20- to 25-year outcome for our original cohort of patients with a myelomeningocele treated in a nonselective, prospective manner. Methods: Of the initial 118 children, 71 patients were available for our most recent review. Nineteen patients have been lost to follow-up and 28 patients have died. Data were collected on: motor level, shunt status, education/employment, seizure history, mobility, bladder/bowel continence, tethered cord, scoliosis, latex allergy, posterior cervical decompression, tracheostomy and/or gastrostomy tube. Results: Mortality (24%) continues to climb into young adulthood. Eighty-six percent of the cohort have cerebrospinal fluid diversion, with 95% having undergone at least one shunt revision. Thirty-two percent have undergone a tethered cord release, with 97% having an improvement or stabilization in their preoperative symptoms. Forty-nine percent have scoliosis, with 43% eventually requiring a spinal fusion. Sixteen patients (23%) have had at least one seizure. Eighty-five percent are attending or have graduated from high school and/or college. More than 80% of young adults have social bladder continence. Approximately 1/3 of patients are allergic to latex, with 6 patients having experienced a life-threatening reaction. Conclusion: At least 75% of children born with a myelomeningocele can be expected to reach their early adult years. Late deterioration is common. One of the greatest challenges in medicine today is establishing a network of care for these adults with spina bifida. Copyright (C) 2001 S. Karger AG, Basel.