【作者】 陈姗； 李建华； 吴方超； 廖志平； 宣丽华；

【Author】 CHEN Shan;LI Jian-hua;WU Fang-chao;LIAO Zhi-ping;XUAN Li-hua;Department of Acupuncture and Moxibustion,The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine);Department of Rehabilitation,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University;

【机构】 浙江中医药大学附属第一医院(浙江省中医院)针灸科； 浙江大学医学院附属邵逸夫医院康复医学科；

【摘要】 目的探讨儿童脊髓栓系综合征伴神经源性膀胱的评估及治疗方法。方法对1例儿童脊髓栓系综合伴神经源性膀胱患者的临床资料作回顾性分析。结果 12岁男性患者,因"脊膜膨出术后排尿困难11年余"就诊。神经系统检查显示,患者四肢肌力、感觉正常,鞍区感觉正常,双侧直腿抬高试验正常,肛周感觉正常,球-肛门反射存在。腰骶椎MRI结果显示:脊髓圆锥末端位于S3,并与骶管内脂肪信号影相连,膀胱体积增大,肾盂肾盏扩张,双侧输尿管扩张,MRI诊断:1.脊髓低位、栓系;2.神经源性膀胱并双侧输尿管、肾积水。考虑患者主要症状为排尿困难,结合患者病史及影像学表现,初步判断脊髓栓系综合征伴神经源性膀胱,经3周的药物治疗、针灸以及康复训练后,膀胱功能改善。结论儿童脊髓栓系综合征伴神经源性膀胱易发生尿路感染、肾功能损伤,需完善膀胱功能的影像学、动力学与生理学评估,进行药物、针灸以及康复治疗结合的方式改善膀胱功能。更多还原

【Abstract】 Objective To investigate the evaluation and treatment of tethered cord syndrome with neurogenic bladder in children.Methods The clinical data of a child with tethered spinal cord combined with neurogenic bladder were retrospectively analyzed.Results A 12-year-old male patient came to the clinic because of " dysuria after the surgery of spinal meningocele for more than 11 years".Neurological examination revealed normal muscle strength and sensation in the extremities,normal sensation in the saddle region,negative Lasegue sign bilaterally,normal perianal sensation,presence of bulb-anal reflexes.MRI results of lumbosacral vertebrae showed that the end of the conus spinal cord was located in S3,and was connected with the fat signal shadow in the sacral canal.The bladder volume increased,renal pelvis and calyceae dilated,and bilateral ureter dilated.MRI diagnosis:1.Low and tethered spinal cord;2.Neurogenic bladder with bilateral ureter and hydronephrosis.Considering that the main symptom of the patient was dysuria,combined with the patient’s medical history and imaging findings,the tethered cord syndrome with neurogenic bladder was preliminarily judged.After 3 weeks of drug treatment,acupuncture,and rehabilitation training,the bladder function was improved.Conclusion Children with tethered cord syndrome with neurogenic bladder are prone to urinary tract infection and renal injury.It is necessary to improve the imaging,kinetic and physiological evaluation of bladder function,and to improve the bladder function by combining drugs,acupuncture,and rehabilitation therapy.更多还原