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目的 探讨及评价脊髓栓系的尿动力学表现及临床意义。方法 对 6 6例脊髓栓系患儿行尿动力学检查、MRI和排泄性膀胱尿道造影。结果 5 8例患儿发现有尿动力学异常改变 ,逼尿肌反射亢进 33例 ,反射低下 2 5例 ,逼尿肌括约肌不协调 2 7例。 5 4例膀胱顺应性下降 ,逼尿肌压增加 ,5 3例残余尿增加 ,5 1例膀胱容量减少。 8例尿动力学表现正常。脊髓圆锥位置正常 5例 ,位于L3～L5间 32例 ,L5以下 2 9例。输尿管反流 16例。结论 脊髓栓系可导致尿动力学发生不同的异常改变 ,脊髓圆锥位置与尿动力学表现的类型及上尿路损害无相关关系 ,上尿路损害与逼尿肌括约肌不协调、逼尿肌压和患儿的年龄密切相关。尿动力学检查是评价下尿路功能和治疗的客观指标。
Objective To investigate and evaluate the urodynamic characteristics and clinical significance of tethered cord. Methods Sixty-six children with tethered cord were examined with urodynamics, MRI and urinary bladder urethra. Results Fifty-eight children were found to have abnormal urodynamic changes, 33 cases of detrusor hyperreflexia, 25 cases of low reflex, and 27 cases of uncoordinated detrusor sphincter. Fifty-four cases of bladder compliance decreased, detrusor pressure increased, 53 cases of residual urine increased, 51 cases of bladder capacity decreased. Eight cases of normal urodynamic performance. Spinal cone position in 5 cases normal, located in L3 ~ L5 in 32 cases, L5 following 29 cases. Ureteral reflux in 16 cases. Conclusions The tethered cord can cause different abnormal changes in urodynamics. There is no correlation between the location of conus spinal cord and the type of urodynamics and the damage of upper urinary tract. The upper urinary tract injury is not coordinated with detrusor sphincter and the detrusor pressure And the age of children are closely related. Urodynamic examination is to evaluate the lower urinary tract function and treatment of objective indicators.