隐性脊柱裂伴局部多毛症的治疗

隐性脊柱裂如无严重腰痛 ,大小便失禁等情况 ,并不需手术治疗 ,而伴发的局部多毛症严重影响患者外观 ,给患者生理、心理均带来不良影响。我科自 1 989年以来收治 7例隐性脊柱裂伴局部多毛症患者 ,治疗效果满意 ,报告如下。1　临床资料1 .1　一般资料1 .1 .1　本组 7例 ,男 1例 ,女 6例。年龄 8岁～ 2 6岁。胸椎隐性脊柱裂伴发的多毛症 1例 ,腰骶部隐性脊柱裂伴发的多毛症 6例。1 .1 .2　治疗方法　胸背部多毛症 1例 ,切除多毛区皮肤 ,创面拉拢缝合。腰骶部多毛症 6例 ,切除多毛区皮肤后反鼓切取中厚皮片回植修复创面。1 .1 .3　随访结果　所…     

强脉冲光子治疗隐性脊柱裂伴发的局部多毛症

目的探讨强脉冲光子(intensepulsedlight,IPL)对隐性脊柱裂伴发局部多毛症的脱毛效果。方法应用ELITEplusIPL脱毛系统对8例隐性脊柱裂伴发的多余毛发进行治疗,IPL输出波长为610~1000nm,光斑面积为50mm×10mm,每列脉冲由4~15个分脉冲组成,其分脉宽为5ms,延时时间为2~20ms,能量为22.3~38.3J/cm2。一般治疗3~5次,每次间隔2个月以上。患者均能耐受治疗时的疼痛,无需麻醉。治疗后无需包扎,常规洗浴。结果经3~5次治疗,毛发基本完全脱落。无水泡、感染、色素沉着及瘢痕形成等并发症。随访6~12个月,只有少许毳毛再生。结论IPL脱毛系统治疗隐性脊柱裂伴发的局部多毛症,疗效可靠,操作简单,治疗速度快,无并发症发生,是一种比较理想的脱毛方法。     

骶神经调节治疗隐性骶椎裂排尿功能障碍一例报告

骶神经调节系通过对骶神经的轻度电刺激调节支配膀胱、括约肌和盆底肌的神经反射 ,以求治疗慢性排尿功能障碍。我们于 2 0 0 1年 4月采用骶神经调节疗法 (ＩｎｔｅｒＳｔｉｍｔｈｅｒａｐｙ)治疗隐性骶椎裂排尿功能障碍 1例 ,效果显著。资料与方法　患者 ,男 ,5 2岁。因尿频、尿急、排尿费力 1年入院。排尿日记提示约 0 .5ｈ排尿 1次 ,每次尿量约5 0ｍｌ。有频繁的急迫性尿失禁 ,无尿痛。夜间尿床 ,尿液持续漏出 ,但无尿意。国际前列腺症状评分 (ＩＰＳＳ) 35分 ,生活质量评估 (ＱｏＬ) 6分。体格检查 :肛门括约肌肌张力正常 ,球海绵体反射…     

隐性脊柱裂致慢性肾功能不全一例

患者：男,14岁。慢性肾功能不全3年,因血液透析后头痛30min于2009年9月8日入院。患者入院前3年由于常年遗尿症到我院儿科就诊,其患者尿蛋白（＋＋＋）,血压170～180／70mmHg,在北京儿童医院就诊,行尿动力学检查：逼尿肌、括约肌失调。     

直肠癌手术对男性性功能和排尿功能的影响

目的 研究直肠癌患术后性功能和排尿功能的变化。方法 对我院79例直肠癌患通过凋查的方式调查术后性功能和排尿功能情况，并按年龄、术式进行回顾性分析。结果 性功能障碍小于40岁患为37．5%，40-59岁为60．4％，大于60岁为95．7％。Miles术后并发性功能障碍为80．5％，近期排尿困难为46．3％(19／41)，远期排尿困难为4．9％(2／41)；Dixon术后并发性功能障碍55．3％，近期排尿困难为28．9%(11／38)，无远期排尿困难。结论 男性直肠癌患术后性功能和排尿功能障碍发生率高。手术时患的年龄和手术方式对其发生率有直接影响。保留植物神经的直肠癌根治术可有效地减少患术后忡功能和排尿功能暗碍。     

直肠癌手术对男性性功能和排尿功能的影响

目的　研究直肠癌患者术后性功能和排尿功能的变化。方法　对我院 79例直肠癌患者通过调查的方式调查术后性功能和排尿功能情况 ,并按年龄、术式进行回顾性分析。结果　性功能障碍小于 40岁患者为 3 7.5 % ,40 -5 9岁为 60 .4% ,大于 60岁为 95 .7%。Miles术后并发性功能障碍为 80 .5 % ,近期排尿困难为 46.3 % (1 9 41 ) ,远期排尿困难为 4.9% (2 41 ) ;Dixon术后并发性功能障碍5 5 .3 % ,近期排尿困难为 2 8.9% (1 1 3 8) ,无远期排尿困难。结论　男性直肠癌患者术后性功能和排尿功能障碍发生率高。手术时患者的年龄和手术方式对其发生率有直接影响。保留植物神经的直肠癌根治术可有效地减少患者术后性功能和排尿功能障碍     

直肠癌根治术中保留盆腔自主神经对男性性功能和排尿功能的影响

目的探讨直肠癌根治术中保留盆腔自主神经对男性性功能和排尿功能的影响。方法110例男性直肠癌患者行保留盆腔自主神经的直肠癌根治术,Dukes A期48例完全保留自主神经(Ⅰ型),Dukes B期53例保留双侧盆神经丛(Ⅱ型),Dukes C期9例保留一侧盆神经丛(Ⅲ型)。结果Ⅰ、Ⅱ和Ⅲ型患者在性功能和排尿功能方面的差异有统计学意义(P<0.05),局部复发率分别为2.08%,11.32%和22.22%,其差异有统计学意义(P<0.05),总的5年生存率为60.91%。结论直肠癌根治术中保留盆腔自主神经,可降低病人术后性功能障碍和排尿功能障碍发生率,提高病人生存质量。     

婴幼儿囊性脊柱裂的手术治疗

脊柱裂是常见的先天性脊柱脊髓畸形,可合并多种病理改变。常引起脊髓,包括感觉、运动及括约肌功能障碍等神经症状。作者总结了我科１０年来婴幼儿囊性脊柱裂１４２例手术治疗经验,阐述了本病的外科病理基础及手术方法要点,报告如下。１临床资料１１一般资料本组１４...     

隐性骶椎裂致排尿障碍的尿动力学及X线影像学研究

分析了３１例隐性骶椎裂患者行尿动力学及Ｘ线影像学检查结果。尿动力学显示反射性膀胱１９例，无反射性膀胱１２例；括约肌协同正常１４例，外括约肌协同失调７例，内括约肌协同失调１０例。结果提示：Ｓ１或Ｓ２部位的隐性骶椎裂易引起排尿障碍；隐性骶椎裂部位、程度与排尿障碍表现、神经源膀胱类型无对应关系；隐性骶椎裂致排尿障碍的病理改变是一个慢性长期的过程，病程较长者临床症状较重。作者认为治疗应以纠正逼尿肌与括约肌失衡，改善排尿为目的。     

直肠癌根治术中保留盆腔自主神经对男性性功能、排尿功能及局部复发率的影响

排尿功能及性功能障碍是直肠癌根治术后较常见的并发症,近年来国内外一些研究发现,在直肠癌根治术中实施全直肠系膜切除(TME)时,完全或部分保留盆腔自主神经(Pelyic autonomic nerve preservation,PANP),可以降低术后排尿和性功能障碍的发生率.但PANP是否会影响手术的根治性,是否会增加患者术后的局部复发率,存在争议.本文回顾分析我院2000年1月～2003年6月在直肠根治术中实施和未实施PANP各46例病人术后排尿及性功能障碍的发生率及局部复发率,研究PANP在直肠癌根治术的应用价值.     

Segmental wire fixation for lumbar spondylolysis associated with spina bifida occulta

Introduction  The effectiveness of segmental wire fixation technique in repairing lumbar spondylolysis has already been reported. However, whether the technique can be indicated for spondylolysis associated with spina bifida, which is occasionally found with spondylolysis, is not well known. In this study, the authors report the mid-term clinical outcome of the procedure performed in patients with symptomatic lumbar spondylolysis associated with spina bifida occulta. Materials and methods  Among 20 patients with symptomatic lumbar spondylolysis who underwent segmental wire fixation between 1996 and 2001, four patients associated with spina bifida occulta were evaluated with an average of 32 months follow-up. Bony union at spondylolysis sites and spina bifida was evaluated using plain X-rays and computed tomography (CT) scans. Clinical symptoms were assessed using Japanese Orthopedic Association scores for back pain (JOA scores) and Henderson’s evaluation of functional capacity. Results  The radiographic examinations of the latest follow-ups revealed the following results. Pars defect; in three cases with bilateral defect, one case healed bilaterally and two healed only unilaterally. One case with unilateral defect healed. Spina bifida; two cases showed bony union and two showed no union. Of the four patients operated, two were rated excellent with the remaining two good according to Henderson’s evaluation. The recovery rate of JOA score was averaged at 69.7 ± 23.5%. No serious complications were noted. Conclusions  In four cases associated with lumbar spondylolysis and spina bifida, segmental wire fixation provided satisfactory clinical outcomes.     

Postural sway at ground and bevel levels in subjects with spina bifida occulta

To assess whether the postural function is impaired by comparing the performances in upright standing at ground and bevel levels in adult subjects with spina bifida occulta (SBO). Eighty subjects with SBO (38 with minor type and 42 with major type) and 35 healthy control subjects participated in the study. All participants performed ten tests while standing upright on a platform at ground level (0°, baseline) and on a beveled surface (with their feet in dorsiflexion and plantarflexion at 10° and 20°). Tests were done with their eyes open and closed. The postural sway was examined using a force platform (CATSYS, Danish) that records sway intensity and velocity. Sway intensity and sway velocity were universally associated with group, degree of bevel, open- or closed-eyes condition, and dorsiflexion or plantarflexion after adjusting for age and gender. With respect to sway intensity, the differences of minor or major SBO group were significantly decreased at different bevel degrees when compared with control groups, whereas the differences between minor and major SBO were significant differences at 10° and 20°. With respect to sway velocity, the differences of major SBO group were significantly decreased at different bevel degrees when compared with minor SBO and control groups, whereas the difference in minor SBO was only significant at 0° when compared with control. Group differences (minor SBO vs. control, major SBO vs. control) showed a significant decrease in sway velocity when comparing at 10° than at 0° and at 20° than at 0°. In all subjects with SBO, the sway intensity/velocity values obtained with open eyes and with plantarflexion had lower values, when compared with values obtained with closed eyes and with dorsiflexion. This study supports the hypothesis that SBO impairs control of postural sway in both the resting upright and stressful postures. Our results imply that the larger the bone defect at the lumbosacral midline, the more the group differences in different stressful conditions. Both velocity and intensity were able to reflect the function of the postural sway from our results. This is the first report to add the bevel degree and foot position, as well as visual input as being the part of the study in investigating the postural sway.     

Uroneurological assessment of spina bifida cystica and occulta

AIMS: Spina bifida is a rare but well-documented congenital spinal anomaly comprising a cystic form, which appears in infancy, and an occult form, which appears in late childhood and in adulthood. Herein, we report the results of uroneurological assessment in patients with spina bifida cystica and occulta, with respect to diagnosis and management of the disorders. METHODS: We performed a neurological examination, urinary questionnaire, and urodynamic studies in 28 consecutive patients with urinary symptoms, including 16 with the cystic form (nine male and seven female patients, ages 2 to 25 years), all of whom underwent neonatal surgical management, and 12 with occult form (six men and six women, ages 7 to 32 years) diagnosed by myelography and spinal magnetic resonance imaging who did not undergo surgery. RESULTS: Neurological examination revealed a combination of flaccid and spastic paresis, with dominant lower motoneuron signs in the cystic form, whereas there were dominant upper motoneuron signs in the occult form. Four patients with occult spina bifida presented with urinary symptoms as the sole initial complaint. There was no correlation between neurological findings and urodynamic abnormalities. Urinary incontinence and enuresis were common at all ages, and large post-micturition residuals and vesicoureteral reflux were not uncommon, particularly in the cystic form. Bladder abnormalities in the cystic and occult forms included detrusor hyperreflexia during filling in 38% and 42%, low compliance detrusor in 81% and 67%, supersensitivity to bethanechol in two (100%) patients with the cystic form and in three of four (75%) with the occult form, and impaired bladder sensation in 25% and 8% in each form, respectively. Urethral abnormalities in cystic and occult forms included detrusor/sphincter dyssynergia in 50% and 27%, low Pure max in 56% and 17%, silent sphincter electromyographic activity in 25% and 0%, absent bulbocavernosus reflex in 87% and 56%, absent anal reflex in 100% and 57%, neurogenic motor unit potentials in one patient with cystic form studied and in two of three patients with occult form, respectively. CONCLUSIONS: Spina bifida cystica and occulta present with a wide spectrum of urodynamic abnormalities including upper and lower motoneuron types of bladder and urethral dysfunction. Careful uroneurological assessment and spinal magnetic resonance imaging are important for diagnosing young adult patients with spina bifida occulta because they may present with urinary symptoms as the sole initial complaint and have no other obvious neurological abnormalities.     

Valproic acid sodium-induced spina bifida occulta in the rat

The antiepileptic drug valproic acid is a well-known teratogenic agent; its main target organ is the neuroepithelium neural tube, although skeletal malformations have also been described. The goal of our investigations was to determine whether there is a direct relationship between high doses of valproic acid and vertebral arch openings. On day 9 of gestation, rats were treated with either 0.3 ml physiologic saline or 600 mg/kg valproic acid (VA) given once in the morning and once in the evening (7 h between doses) for a total of 1200 mg/kg. For the teratological investigations, fetuses were examined at 21 days of gestation. Spina bifida occulta was demonstrated in double-stained fetal skeletons by measuring the distance between the cartilaginous ends of each vertebral arch. The most important finding was the very high rate of spina bifida occulta observed with this application regimen. Spina bifida aperta was not observed in our study. A low rate of exencephaly was observed in the treated group (3%). The difference between the control and treated groups was statistically highly significant from the first thoracic to fifth sacral level. The effects of VA are most pronounced from thoracic 9 to the upper lumbar region. The largest gap in vertebral arches was found in the first and second lumbar vertebrae in the VA-treated group. These findings suggest that the peak concentration of VA in the maternal plasma and high bolus administration of VA may be more important for spina bifida occulta than the total dose and infusion of VA. Received: 21 June 1999 / Revised: 25 November 1999 / Accepted: 27 December 1999     

Extradural spinal arachnoid cysts associated with spina bifida occulta

Summary Introduction. Spinal extradural arachnoid cysts are an uncommon cause of neural compression in children. Even more uncommon is the association of such cysts with spina bifida occulta. Material. Two girls, 12 and 8-years-old, presented with left leg pain, deteriorating gait, clinical signs of left L5 and S1 root compression, without bladder or bowel symptoms. The first patient had left foot drop. The second patient had muscle wasting and smaller left foot with pes cavus. Radiographs showed spina bifida occulta of S1 in both. MRI revealed an extradural cyst at the S1 level, indenting the thecal sac and the L5 and S1 roots. At operation in both patients a large arachnoid cyst arising from a small dural defect in the axilla of the left S1 root was compressing and displacing it and the dural sac. It was removed and the defect was repaired. The first patient improved with complete recovery of the foot drop. An MRI at 12 months showed no cyst recurrence. The second patient made good recovery initially, but at 10 months developed recurrent symptoms. An MRI scan showed recurrence of the cyst with root compression. On repeat exploration a different dural defect was identified in a more anterior position and was repaired. Discussion. The coexistence of extradural arachnoid cyst and corresponding bifid spinal segment has not been described previously. It raises the suspicion that the dural defect giving rise to the arachnoid cyst may be due to segmental dural dysgenesis in the context of the dysrhaphic neuroectodermal malformation.     

骶神经调节治疗隐性骶椎裂排尿功能障碍的探讨

目的：探讨骶神经调节治疗隐性骶椎裂排尿功能障碍的效果和安全性。方法：对1例隐性骶椎裂排尿功能障碍患者进行经皮穿刺骶神经测试、永久电极和可程控式骶神经调节器植入术,比较测试和植入术前后的排尿日记,记录不良反应。结果：测试期间平均每次排尿量增加52％－190％,每天尿急发生率降低42％－100％;植入术后1个月的平均每次排尿量增加169％,平均排尿间隔时间延长102％。无明显不良反应。结论：骶神经调节是一种创伤小、安全有效的治疗方法,可以仍椎裂引起的排尿功能障碍。     

Spina bifida occulta and epidural anaesthesia

Spina bifida occulta occurs in 5-10% of the population, not all of whom display superficial signs. Attempted epidural puncture at the level of the lesion will almost certainly result in a dural tap. We report a patient who developed a postural headache after Caesarean section under epidural anaesthesia, in whom radiography of the spine later demonstrated spina bifida occulta. This problem has not been described previously, although it is unlikely to be an isolated case.     

Spina bifida occulta in isthmic spondylolisthesis: a surgical trap

An 11-year-old girl presented with symptomatic grade IIB isthmic type spondylolisthesis, with an elongated pars, confirmed on magnetic resonance imaging (MRI). Posterolateral in situ fusion of L5/S1 was performed. At surgery, a significant bony defect in the posterior aspect of S1 was noted. Awareness of this possible co-existence is paramount if iatrogenic damage to neural elements is to be avoided during surgery.     

Long-term outcome in surgically treated spina bifida cystica

This report describes the long-term operative outcome of 72 patients with spina bifida cystica. The period of follow-up was between 4 and 20 years. In our series, 17 patients died, with the mortality rate increasing as the lesions were more rostral. All cases involving only a meningocele are living without handicap. The cases of spina bifida cystica with hydrocephalus had higher morbidity and mortality when compared to those without hydrocephalus. We conclude that the rostro-caudal location, the content of the sac, and whether there is associated hydrocephalus are important factors influencing the long-term prognosis of spina bifida cystica.