腰椎间盘突出症合并有下尿路症状患者临床与尿动力学研究

Clinical and urodynamic analysis on protrusion of lumbar intervertebral disc patients with urinary voiding dysfunction

目的:观察腰椎间盘突出引起的下尿路症状的特点和尿动力学的变化。方法:将58例腰椎间盘突出症合并下尿路症状患者,根据椎间盘突出节段分为高位椎间盘突出组(A组,T 12-L 3节段,26例)和低位突出组(B组,L 3-S 1节段,32例),并根据不同椎管内容积侵占率(腰椎CT图像)、临床JOA评分评分分组,观察患者所表现的下尿路功能障碍特点和尿动力学检查情况。结果:①本组患者的下尿路症状有尿路刺激症状、尿路梗阻症状或者混合型症状。但B组中有2例不能自主排尿,而A组则没有。②根据JOA评分将其分为15分以上组(>15分)与0~15分组;但两组均为评分较低患者占更高,两组间比较无统计学差异。③两组间在重度和轻、中度侵占率者占比比较有统计学差异。尿动力学检查发现,低位突出组残余尿量分别(36.1±22.0)ml和(132.9±63.50)ml,两者比较差异有统计学意义(P<0.05)。此外,两组的膀胱顺应性间数值分别为19.50(16.2~49.8)ml/cmH2O和44.0(30.2~63.4)ml/cmH2O,两者比较差异有统计学意义(P<0.05)。结论:高位和低位腰椎间盘突出均可出现下尿路功能障碍表现,且椎管侵占严重者、临床评估神经功能评分较低者所占比例更高。高位腰椎间盘突出患者低顺应性膀胱发生率较高;而低位腰椎间盘突出症高顺应性膀胱发生率较高,可发生尿潴留。

Objective:To investigate the clinical features of bladder and urethra dysfunction protrusion of lumbar intervertebral disc patients with urinary voiding dysfunction,and to find Clinical value of urodynamics.Mtthods:A total of 58 patients 26 cases higher level protrusion(group A)and 32 cases lower level protrusion(group B)were recruited in,according to the eriteria of inclusion and exclusion.The patients were classifled into different groups,according to JOA scores and ratios of spinal canal encroachment.A rerrospective analysis of the clinical features and urodynamic data of the patients were conducted.Reslult:Urinary tract irritation symptoms,and symptoms of urinary tract obstruction were found in the two groups,and 2 cases of inability to urinate autonomously were found in group A.Patients of lower JOA scores took a higher proportion in both groups.Patients of with mild and moderate ratios of spinal canal encroachment took a higher proportion in group A in contrast to I group B.The residual urine volumes(36.1±22.0 ml) of group A were statistical different between those(132.9 ±63.50 ml).The incidence of low compliance bladder in the group A is 4/26,and the incidence of high compliance bladder in the sacral is 11/22.Concluslon:Urinary tract irritation symptoms,and symptoms of urinary tract obstruction were found in lumbar intervertebral disc patients with urinary voiding dysfunction,no matterwhich level.The urodynamics difference between different level protrusion of lumbar disk were observed in bladder compliance and residual urine volumes.Urodynamics may be potential value for Prognostic evaluation.