L_1椎体爆裂骨折合并脊髓圆锥损伤术后患者膀胱逼尿肌功能恢复的相关因素

Related factors of patient between the L1 burst fracture complicating conus medullaris injury with preoperative and postoperative detrusor muscle of bladder function recovery

[目的]研究L1节段爆裂骨折合并圆锥损伤手术后患者膀胱逼尿肌功能恢复的相关因素。[方法]回顾分析35例L1椎体爆裂性骨折合并脊髓圆锥损伤患者的临床资料。所有患者根据影像学和临床查体情况后行后路或侧前方减压脊柱稳定手术。记录手术前后膀胱功能JOA评分。[结果]所有患者均有鞍区感觉障碍,其中25例鞍区感觉减退,10例感觉消失。比较鞍区感觉减退组和感觉消失组的膀胱尿动力学参数,如最大自由尿流率、自主排尿量、最大尿流速时逼尿肌压力、逼尿肌最大压力时的尿流速和逼尿肌的最大压力。感觉减弱组显著优于感觉消失组,组间比较差异具有统计学意义(P<0.05)。两组患者术后随访2年中,感觉减退组16例3个月内大小便恢复正常,7例术后6个月内恢复正常,2例术后恢复较差需要导尿;感觉消失组恢复正常的比例显著低于感觉减退组(P<0.05)。[结论]L1椎体爆裂骨折并圆锥损伤手术的患者术后膀胱逼尿肌功能恢复是较为重要的评价预后指标,而其恢复同患者术前感觉区域的损伤情况具有重要关系。

[ Objective ] To study related factors of the patients between the L1 burst fracture complicating conus medullaris injury with preoperative and postoperative detrusor muscle of bladder function recovery. [ Method] Retrospective analysis clini- cal data with 35 cases with the L1 burst fracture complicating conus medullaris injuries were analyzed. According to imaging in- formation and physical examinations, patients were performed selective operation with posterior or anterolateral decompression and stabilization and JOA score of bladder function were recorded before and after surgery. [ Result ] All patients had perineum or saddle anesthesia. Of those, 25 cases had perineum or saddle hypesthesia, 10 cases had the saddle sensory deprivation. Bladder urine dynamics parameters were compared between the saddle hypesthesia group （25 cases） and sensory deprivation group （10 cases）, such as the largest free urinary flow rate, automatic micturition rate, mean free urinary flow rate, independent urine output,residual urine volume, urinary flow rate with maximum detrnsor pressure, detrusor maximum pressure of urinary flow rate,detrusor maximum pressure. With the saddle hypesthesia group was significantly superior to sensory deprivation group and had statistically significant difference （P 〈 0.05）. Two groups of patients in the follow-up of 2 years, hypesthesia group of 16 cases of 3 months relieve oneself returned to normal, 7 cases of postoperative 6 months to return to normal, 2 cases of post- operative recovery poor and need to catheterize. The sensory deprivation group recovery to normal proportion was significantly lower than the hypesthesia group （ P 〈 0.05 ）. [ Conclusion ] Postoperative bladder detrusor function recovery of patient with the first lumbar spine burst fracture complicating conus medullaris injury is an important prognostic indicator, and the recovery of patients with preoperative perineum or saddle damage has an important relationship.