腰椎间盘突出伴马尾神经综合征患者延迟手术减压的长期随访分析（英文）

发布时间：2018-11-08 10:45

【摘要】：目的分析腰椎间盘突出伴马尾神经综合征患者接受延迟手术减压后神经系统及排尿功能恢复的长期随访结果。方法将35例符合腰椎间盘突出伴马尾神经综合征患者纳入此次随访,着重关注患者术前及术后的膀胱排空功能、排便功能、性功能、鞍区感觉及下肢神经功能恢复情况;6例患者术前术后均接受尿动力学检查。结果 35例患者中,12例完全性马尾神经综合征患者平均延迟手术减压时间为4.1+3.9周,23例不完全性马尾神经综合征患者平均延迟减压时间为5.5+7.6周;所有患者随访3~110月(平均43.0+28.9月)。23例不完全性马尾神经综合征患者中,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征患者中,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例有完整术前及术后尿动力学结果的患者中,随访尿动力学检查提示排尿时腹压明显上升,残余尿量较术前明显减少,其中4例患者初次排尿感觉时膀胱容量恢复正常。结论对接受延迟手术的腰椎间盘突出伴马尾神经综合征患者,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。尿动力学检查提示膀胱排空功能恢复可能为膀胱感觉恢复引发的排尿时腹内压代偿升高所致。膀胱功能恢复的关键策略为促进膀胱逼尿肌收缩功能的恢复。
[Abstract]:Objective to analyze the long-term follow-up results of patients with lumbar disc herniation and cauda equina syndrome after delayed decompression of nervous system and urination. Methods 35 patients with cauda equina syndrome and lumbar intervertebral disc herniation were included in the follow-up, focusing on the recovery of bladder emptying, defecation, sexual function, sensory and lower extremity nerve function before and after operation. All 6 patients underwent urodynamic examination before and after operation. Results the average delayed decompression time was 4.1 3.9 weeks in 12 patients with complete cauda equina syndrome and 5.5 7.6 weeks in 23 patients with incomplete cauda equina syndrome. All patients were followed up from 3 to 11 months (mean 43.028.9 months). Of the 23 patients with incomplete cauda equina syndrome, 19 were completely recovered, and 4 had slight changes in the sensory function of the Sellar region or lower extremity. In 12 patients with complete cauda equina syndrome, 2 patients recovered completely, 4 patients had mild Sellar area or lower extremity sensory disturbance and 2 patients had occasional constipation, the remaining 6 patients had different degree of Sellar region sensory disorder. In 6 patients with complete preoperative and postoperative urodynamic results, the results of follow-up urodynamic examination showed that abdominal pressure was significantly increased, and residual urine volume was significantly decreased in 6 patients with dysuria and defecation dysfunction. The bladder volume returned to normal in 4 patients at the first time of urination. Conclusion for the 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. Urodynamic examination suggested that the recovery of bladder emptying function might be due to the increase of intra-abdominal pressure during urination induced by bladder sensory recovery. The key strategy of bladder function recovery is to promote the recovery of bladder detrusor contraction function.
【作者单位】：南方医科大学南方医院脊柱外科;南方医科大学南方医院泌尿外科;
【分类号】：R687.3

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