Krebs Jörg, Grasmücke Dennis, Pötzel Tobias, Pannek Jürgen
Clinical Trial Unit; Swiss Paraplegic Centre, Nottwil, Switzerland.
Neurourology; Swiss Paraplegic Centre, Nottwil, Switzerland.
Neurourol Urodyn. 2016 Feb;35(2):241-5. doi: 10.1002/nau.22706. Epub 2014 Dec 18.
To investigate the occurrence of Charcot spinal arthropathy (CSA) after sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) of the bladder in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) as a result of spinal cord injury (SCI).
Retrospective evaluation of patients who had undergone SDAF/SARS at a single SCI rehabilitation centre. The occurrence rate of stimulation dysfunction was determined, and the medical records and radiological images of the included patients were examined for CSA. The diagnosis of CSA was based on radiological criteria. The occurrence rate of CSA was estimated for all SARS patients and for those with SARS dysfunction, and the odds ratios (OR) for the occurrence of CSA were calculated.
In 11/130 SARS patients (8%), CSA was observed a median 8 years (95% CI 5-16 years) after SDAF/SARS or a median 21 years (95% CI 9-41 years) after SCI had occurred. The median follow-up time was 14 years (range 6-25 years). The proportion of patients with CSA was significantly (P = 0.036) greater in patients with SARS dysfunction (7/41) than in patients without SARS dysfunction (4/89). The odds of CSA were four times greater (OR 4.3, 95% CI 1.0-21.5) in patients with SARS dysfunction compared to those without. Furthermore, the odds of CSA were 20 times greater (OR 20.2, 95% CI 8.4-47.0) in patients with SARS compared to those without.
Charcot spinal arthropathy should be considered a potential long-term complication of SDAF/SARS, and spinal instability is a possible reason for SARS dysfunction.
调查因脊髓损伤（SCI）导致神经源性下尿路功能障碍（NLUTD）的患者在膀胱骶神经去传入术（SDAF）和骶前根刺激术（SARS）后夏科氏脊柱关节病（CSA）的发生情况。
对在单一SCI康复中心接受SDAF/SARS治疗的患者进行回顾性评估。确定刺激功能障碍的发生率，并检查纳入患者的病历和影像学图像以评估CSA。CSA的诊断基于影像学标准。估计所有SARS患者以及有SARS功能障碍患者的CSA发生率，并计算CSA发生的比值比（OR）。
在11/130例SARS患者（8%）中，观察到CSA发生于SDAF/SARS后中位8年（95%可信区间5 - 16年）或SCI发生后中位21年（95%可信区间9 - 41年）。中位随访时间为14年（范围6 - 25年）。有SARS功能障碍的患者中CSA的比例（7/41）显著高于无SARS功能障碍的患者（4/89）（P = 0.036）。与无SARS功能障碍的患者相比，有SARS功能障碍的患者发生CSA的几率高4倍（OR 4.3，95%可信区间1.0 - 21.5）。此外，与无SARS的患者相比，有SARS的患者发生CSA的几率高20倍（OR 20.2，95%可信区间8.4 - 47.0）。
夏科氏脊柱关节病应被视为SDAF/SARS潜在的长期并发症，脊柱不稳定可能是SARS功能障碍的一个原因。
