脊柱均匀短缩脊髓轴性减压术治疗脊髓拴系综合征膀胱功能的分析  

Homogeneous spinal-shortening axial decompression procedure for bladder function of tethered cord syndrome

作　　者：王海波[1] 徐锡明[1] 孙璟川[1] 王元[1] 张斌[1] 王英杰[1] 张鹏[1] 郭永飞[1] 杨海松[1] 史建刚[1] WANG Haibo;XU Ximing;SUN Jingchuan(Department of Spine Surgery, Changzheng Hospital, Shanghai, 200003, Chin)

机构地区：[1]第二军医大学长征医院脊柱二科,上海市200003

出　　处：《中国脊柱脊髓杂志》2018年第5期440-446,共7页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金(编号：81271351)

摘　　要：目的:评估脊柱均匀短缩脊髓轴性减压术(homogeneous spinal-shortening axial decompression,HSAD)后脊髓拴系综合征患者膀胱功能的改善情况。方法:回顾性分析我院2013年4月~2016年7月接受HSAD治疗的脊髓拴系综合征患者共16例,男6例,女10例,年龄11~64岁,平均29.9±16.7岁。术前、术后3个月、6个月、12个月及末次随访均采用国际尿失禁问卷简表(ICI-Q-SF)评分评估患者膀胱功能,术前及末次随访行尿流动力学检查,评估膀胱安全容量、逼尿肌漏尿点压、膀胱顺应性、残余尿量等指标变化情况。结果:16例患者均获得随访,随访15~54个月(32.4±10.1个月)。术前ICI-Q-SF评分为14.94±4.15分,术后3个月时为9.88±4.43分,术后6个月时为8.63±4.17分,术后12个月时为8.19±4.22分,末次随访时为7.63±4.40分,术后各次随访结果与术前相比差异均具有统计学差异(P<0.05)。末次随访时,膀胱安全容量由术前155.31±75.33ml增加至252.69±64.94ml,差异有统计学意义(P<0.05)。逼尿肌漏尿点压由术前43.12±17.96cm H2O降至30.44±13.96cm H2O,差异具有统计学意义(P<0.05);膀胱顺应性由术前8.56±5.78ml/cm H2O升高至23.10±12.05ml/cm H2O,差异具有统计学意义(P<0.05)。膀胱残余尿量术前140.44±113.66ml减小至84.06±70.07ml,差异无统计学意义(P>0.05)。结论:HSAD可明显改善脊髓拴系综合征患者的泌尿功能及尿流动力学指标,是一种可供选择的治疗脊髓拴系综合征的手术方式。Objectives： To evaluate the outcomes of bladder function in patients with tethered cord syndrome （TCS） by homogeneous spinal-shortening axial decompression（HSAD）. Methods： From April 2013 to July 2016, 16 patients（6 males, 10 females） with TCS, aged 11-64 years old（average, 29.9±16.7 years old）, underwent HSAD. The ICI-Q-SF score was used to evaluate pre- and post-operative bladder function. The pre- and post-operative parameters, including safe bladder capacity, bladder compliance, detrusor leak point pressure and bladder residual urine volume, were measured according to urodynamic. Results： 16 patients were followed up for 15 to 54 months（average, 32.4±10.1months）. The ICI-Q-SF score was decreased from preoperative 14.94±4.15 to 7.63±4.40 at final follow-up（P〈0.01）. The safe bladder capacity was increased from preoperative 155.31±75.33ml to 252.69±64.94ml at final follow-up（P〈0.05）. The bladder compliance was improved from preoperative 8.56±5.78ml/cmH2O to 23.10±12.05ml/cmH2O at final follow-up（P〈0.05）. The detrusor leak point pressure was decreased from preoperative 43.12±17.96cmH2O to 30.44±13.96cmH2O at final follow-up（P〈0.05）. The bladder compliance was increased from preoperative 8.56±5.78ml/cmH2O to 23.10±12.05ml/cmH2O at final follow-up（P〈0.05） The bladder residual urine volume had no statistic difference（P〉0.05）. Conclusions： HSAD could obviously improve the urinary function and urodynamic indexes of patients with TCS.

关 键 词：脊柱均匀短缩脊髓轴性减压术 脊髓栓系综合征 尿流动力学 

分 类 号：R687.3[医药卫生—骨科学] R744.2[医药卫生—外科学]