急诊与非急诊减压手术后结核性压迫性不完全性脊髓损害患者男性性功能的比较

Comparison of emergency and non-emergency decompression surgeries in the male sexual function of patients with incomplete tuberculosis compression of spinal cord after

目的比较急诊与非急诊减压手术后结核性压迫性不完全性脊髓损害患者的男性性功能。方法将102例脊柱结核性压迫性不完全性脊髓损害男性患者分成两组,观察组43例有急诊手术指征并行急诊手术,对照组59例无急诊手术指征并给予常规抗结核治疗2周后才手术治疗。通过Frankel分级评定神经功能,采用勃起功能国际指数评价患者性功能,并对性功能障碍男性患者进一步测定其反射性勃起和精神性勃起的情况。结果最后获访100例(失访2例)。两组出血量、手术时间等差异无统计学意义(P>0.05)。最后随访时,观察组有12例(29%)患者存在性功能障碍,对照组有17例(29%),两组性功能障碍发生率差异无统计学意义(P>0.05);观察组Frankel B级性功能障碍发生率高于D级和E级,C级高于E级,差异有统计学意义(P<0.05),而B级与C级之间、C级与D级之间、D级与E级之间性功能障碍发生率差异无统计学意义(P>0.05)。29例男性性功能障碍患者中,5例(观察组3例,对照组2例)既无反射性勃起也无精神性勃起,6例(观察组1例,对照组5例)只有反射性勃起,8例(观察组3例,对照组5例)只有精神性勃起,10例(观察组5例,对照组5例)为混合性勃起。结论在结核性压迫性不完全性脊髓损害患者中,不论急诊与非急诊减压手术,术后患者性功能障碍发生率均较高,随着压迫脊髓损害程度加重,性功能障碍的发生率明显升高。当结核压迫脊髓发生在胸腰段以上时,性功能障碍主要表现为精神性勃起障碍;结核压迫脊髓损害发生在骶段时,性功能障碍主要表现为反射性勃起障碍。

Objective To compare efficacy of emergency and non - emergency decompression surgeries on the male sexual function of patients with incomplete tuberculosis compression of spinal cord after. Methods A total of 102 male patients with spinal tuberculosis with incomplete spinal cord damage were divided into two groups according to emer- gency surgical indication： the experimental group （43 cases） and control group （59 cases）. The international index of e- rectile function was applied to assess sexual function, and furthermore, the patients with sexual dysfunction were further determined with reflectivity erection and psychogenic erectile condition. Frankel grade was applied for assessment of neural function. Results A total of 100 cases were followed - up （ lost to follow - up of two cases）. There was no significant difference in blood loss, operating time, or etc. between the two groups. There were 12 patients （29%） with sexual dys- function in experimental group, while 17 cases （29%） in control group, with no significant difference. In the experimen- tal group, the incidence of sexual dysfunction in Frankel grade B was significantly higher than that in grade D and grade E （ P 〈 0. 05 ）, and higher in Frankel grade C than that in grade E （ P 〈 0. 05）. In the 29 cases of male sexual dysfunction, neither reflex nor psychogenic erection, reflex erection alone, psychogenic erection alone, and mixed erection were ob- served in 5, 6, 8 and 10 cases, respectively. Conclusion In the spinal tuberculous patients with incomplete spinal cord injury, regardless of the emergency or non - emergency decompression surgery, there is a higher incidence of sexual dys- function.