脊柱均匀短缩脊髓轴性减压术联合临床康复干预对脊髓拴系综合征术后膀胱功能的影响

Analysis of the bladder function of spinal tethered syndrome with spinal column axial decompression and rehabilitation intervention

目的探讨脊柱均匀短缩脊髓轴性减压术(homogeneous spinal-shortening axial decompression,HSAD)联合康复干预在脊髓拴系综合征(tethered cord syndrome,TCS)患者中的临床效果及对患者膀胱功能的影响。方法选取2016年1月至2018年6月河北省唐山市第二医院收治的TCS患者36例,采用随机数字表分为对照组和观察组,每组18例。对照组采用显微外科手术治疗,观察组采用HSAD治疗,两组术后均给予临床康复干预。采用国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)对两组术前及术后3、6、12个月时的尿失禁程度进行评估。术后12个月时采用MMS Solar尿流动力学检查系统对两组患者膀胱安全容量、逼尿肌漏尿点压、膀胱顺应性和膀胱残余尿量进行检测。观察并比较两组术后并发症发生情况。结果术后3、6、12个月时观察组的ICI-Q-SF评分均低于对照组,差异有显著性(P<0.05)。观察组术后12个月时的膀胱安全容量、膀胱顺应性高于对照组,逼尿肌漏尿点压、膀胱残余尿量低于对照组,差异均有显著性(P<0.05)。两组术后脑脊液漏、尿潴留、医源性神经损伤、椎管内感染和术后粘连再拴系等并发症发生率比较差异无显著性(P>0.05)。结论采用HSAD治疗TCS有助于改善患者膀胱功能,术后加强临床康复护理可降低并发症发生率,值得推广应用。

Objective To investigate the clinical effects of homogeneous spinal-shortening axial decompression(HSAD)combined with rehabilitation intervention in patients with tethered cord syndrome(TCS)and its effect on bladder function.Method Thirty-six patients with TCS who were treated from January 2016 to June 2018 were enrolled.The random number table was divided into control group(n=18)and observation group(n=18).The control group was treated with microsurgery,and the observation group was treated with HSAD.Both groups received clinical rehabilitation intervention.The International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire(ICI-Q-SF)was used to evaluate the degree of urinary incontinence before and after treatment;the MMS Solar urodynamics system was used to safely store bladder and detrusor leakage.Urine puncture and bladder compliance and bladder residual urine volume were measured.Result The ICI-Q-SF scores of the observation group at 3 months,6 months and 12 months after operation were lower than those of the control group(P<0.05).The bladder safety capacity and bladder compliance were higher in the observation group than in the control group.The group(P<0.05);the detrusor leakage voltage and bladder residual urine volume in the observation group were lower than those in the control group at 12 months after operation(P<0.05);cerebrospinal fluid leakage and urinary retention after operation in the observation group and the control group.There was no significant difference in the incidence of iatrogenic nerve injury and intraspinal infection and postoperative adhesion re-tethering(P>0.05).Conclusion The use of HSAD in patients with TCS can improve the bladder function of patients.Strengthening the clinical rehabilitation of patients after surgery can reduce the incidence of complications,which is worthy of popularization and application.