腰椎间盘突出伴马尾神经综合症延迟手术后神经功能的随访分析
发布时间：2018-10-31 18:46
【摘要】：一、研究背景:腰椎间盘突出伴马尾神经综合症(Cauda equina symdrome caused by Lumbar disc protrusion,CES-LDP)是一种少见的,由各种原因引起马尾神经严重受压致神经功能受损的一种疾病。目前提倡早期甚至急诊手术减压,及时解除神经压迫,能防止持续性神经功能受损,保留神经功能恢复潜能,以期达到神经功能恢复。但目前关于该类患者延迟手术减压(延迟周以上)的神经功能恢复状况及长期随访结果,鲜有文献报道。临床实践中,由于经济、就医意识、社区医疗对该疾病意识缺乏,延迟手术情况时有发生。二、研究目的:探讨腰椎间盘突出伴马尾神经综合症患者接受延迟手术减压疗效及其神经功能恢复的长期随访结果。三、研究方法:回顾性分析35例有完整临床病历资料的腰椎间盘突出伴马尾神经综合症患者;如符合:1)充盈性尿失禁需尿管支持、2)大便失禁、3)勃起功能丧失、4)鞍区感觉消失中一项以上,为完全性马尾神经综合症组,部分丧失以上四项功能,则为不完全性马尾神经综合症组;随访着重关注患者术前及术后膀胱排空功能、排便功能、性功能及鞍区感觉改变并作术前术后对比。四、研究结果:35例患者中,完全性马尾神经综合症患者平均延迟手术减压时间为4.1±3.9周,不完全性马尾神经综合症患者平均延迟减压时间为5.5±7.6周;平均随访时间为43.0±28.9个月(3-110个月)。23例不完全性马尾神经综合症患者,19例完全恢复,4例存在轻微的鞍区或下肢感觉功能改变。12例完全性马尾神经综合症患者,2例患者完全恢复,4例患者存在轻微鞍区或下肢感觉障碍且其中2例存在偶发便秘,其余6例患者存在不同程度的鞍区感觉障碍、排尿及排便功能障碍。6例患者术前及术后有完整尿动力学结果,随访尿动力学提示排尿时腹压明显上升,残余尿量较术前明显减少,4例患者初次排尿感觉时膀胱容量恢复正常。五、研究结论:对接受延迟手术的腰椎间盘突出伴马尾神经综合症患者,长期随访结果显示多数患者预后良好,神经功能均有不同程度恢复,不完全性组长期随访结局优于完全性组;尿动力学提示膀胱排空功能恢复可能来源于膀胱感觉恢复引发排尿时腹内压代偿升高所致。
[Abstract]:Background: lumbar disc herniation with cauda equina syndrome (Cauda equina symdrome caused by Lumbar disc protrusion,CES-LDP) is a rare disease, which is caused by severe compression of cauda equina nerve. At present, early decompression or emergency operation should be advocated to relieve the nerve compression in time, which can prevent the damage of the sustained nerve function and preserve the recovery potential of the nerve function in order to achieve the recovery of the nerve function. However, there are few reports on the recovery of neurologic function and the results of long-term follow-up in patients with delayed surgical decompression (more than the delayed week). In clinical practice, due to economic, medical awareness, community medical awareness of the disease, delayed surgery occurred from time to time. Objective: to investigate the effect of delayed surgical decompression and neurological function recovery in patients with lumbar disc herniation and cauda equina syndrome. Methods: 35 cases of lumbar disc herniation with cauda equina syndrome were retrospectively analyzed. The results were as follows: 1) filling urinary incontinence required urethral support, 2) fecal incontinence, 3) erectile dysfunction, 4) more than one item of sensory disappearance in the Sellar region, belonging to the group of complete cauda equina syndrome, with partial loss of the above four functions. Incomplete cauda equina syndrome group; The follow-up focused on the changes of bladder emptying function, defecation function, sexual function and Sellar region sensation before and after operation. 4. The results showed that the average delayed decompression time was 4.1 卤3.9 weeks in complete cauda equina syndrome patients and 5.5 卤7.6 weeks in incomplete cauda equina syndrome patients. The mean follow-up time was 43.0 卤28.9 months (3-110 months). Of the 23 patients with incomplete cauda equina syndrome, 19 recovered completely. 12 patients with complete cauda equina syndrome, 2 patients with complete cauda equina nerve syndrome, 4 patients with mild Sellar region or lower extremity sensory dysfunction, 2 patients with occasional constipation, 4 patients had slight Sellar region or lower extremity sensory function changes, 2 patients had complete cauda equina syndrome, 4 patients had mild Sellar area or lower limb sensory dysfunction, 2 patients had occasional constipation. The other 6 patients had different degree of Sellar area sensory disorder, urination and defecation dysfunction, 6 cases had complete urodynamic results before and after operation, and follow up showed that abdominal pressure increased obviously during urination. The residual urine volume was significantly lower than that before operation, and the bladder volume returned to normal at the first time of urination in 4 patients. Conclusion: for patients with prolapse of lumbar intervertebral disc and cauda equina syndrome, the long-term follow-up results showed that the prognosis of most patients was good, and the neurological function recovered in varying degrees. The long-term follow-up outcome of incomplete group was better than that of complete group. Urodynamics suggests that the recovery of bladder emptying function may be due to the increase of intra-abdominal pressure during urination induced by bladder sensory recovery.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2303204
[Abstract]:Background: lumbar disc herniation with cauda equina syndrome (Cauda equina symdrome caused by Lumbar disc protrusion,CES-LDP) is a rare disease, which is caused by severe compression of cauda equina nerve. At present, early decompression or emergency operation should be advocated to relieve the nerve compression in time, which can prevent the damage of the sustained nerve function and preserve the recovery potential of the nerve function in order to achieve the recovery of the nerve function. However, there are few reports on the recovery of neurologic function and the results of long-term follow-up in patients with delayed surgical decompression (more than the delayed week). In clinical practice, due to economic, medical awareness, community medical awareness of the disease, delayed surgery occurred from time to time. Objective: to investigate the effect of delayed surgical decompression and neurological function recovery in patients with lumbar disc herniation and cauda equina syndrome. Methods: 35 cases of lumbar disc herniation with cauda equina syndrome were retrospectively analyzed. The results were as follows: 1) filling urinary incontinence required urethral support, 2) fecal incontinence, 3) erectile dysfunction, 4) more than one item of sensory disappearance in the Sellar region, belonging to the group of complete cauda equina syndrome, with partial loss of the above four functions. Incomplete cauda equina syndrome group; The follow-up focused on the changes of bladder emptying function, defecation function, sexual function and Sellar region sensation before and after operation. 4. The results showed that the average delayed decompression time was 4.1 卤3.9 weeks in complete cauda equina syndrome patients and 5.5 卤7.6 weeks in incomplete cauda equina syndrome patients. The mean follow-up time was 43.0 卤28.9 months (3-110 months). Of the 23 patients with incomplete cauda equina syndrome, 19 recovered completely. 12 patients with complete cauda equina syndrome, 2 patients with complete cauda equina nerve syndrome, 4 patients with mild Sellar region or lower extremity sensory dysfunction, 2 patients with occasional constipation, 4 patients had slight Sellar region or lower extremity sensory function changes, 2 patients had complete cauda equina syndrome, 4 patients had mild Sellar area or lower limb sensory dysfunction, 2 patients had occasional constipation. The other 6 patients had different degree of Sellar area sensory disorder, urination and defecation dysfunction, 6 cases had complete urodynamic results before and after operation, and follow up showed that abdominal pressure increased obviously during urination. The residual urine volume was significantly lower than that before operation, and the bladder volume returned to normal at the first time of urination in 4 patients. Conclusion: for patients with prolapse of lumbar intervertebral disc and cauda equina syndrome, the long-term follow-up results showed that the prognosis of most patients was good, and the neurological function recovered in varying degrees. The long-term follow-up outcome of incomplete group was better than that of complete group. Urodynamics suggests that the recovery of bladder emptying function may be due to the increase of intra-abdominal pressure during urination induced by bladder sensory recovery.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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