Batista J E, Bauer S B, Shefner J M, Kelly M D, Darbey M D, Siroky M B
Children's Hospital, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Urol. 1995 Sep;154(3):1183-7.
We identified urodynamic patterns of lower urinary tract dysfunction in children after anterior spinal artery injury.
Between 1981 and 1993, 6 boys and 1 girl in whom ischemic spinal cord injuries developed after umbilical artery catheterization (4), cardiovascular surgery (2) and spontaneous bleeding from an arteriovenous fistula (1) were evaluated radiologically, neurologically and urodynamically.
Neurological assessment revealed a motor level from T8 to S1 in all 7 children, whereas only 3 had sensory denervation ranging from T8 to L4. Urodynamic studies demonstrated a mixed upper and lower motor neuron pattern in 3 patients, a lower motor neuron lesion only in 3 and a pure upper motor neuron deficit in 1. Treatment consisted of oxybutynin in 5 cases, Credé voiding in 1 and close observation in 1. All children are dry and kidney function has remained stable.
Spinal cord ischemia in children is a rare condition that can arise from a variety of causes, the most common of which are embolism from umbilical artery catheterization and surgical repair of a patent ductus arteriosus. The urodynamic patterns are variable but characteristically they can be upper or lower motor neuron in nature. Precise testing will lead to appropriate therapy to prevent upper urinary tract disease and minimize incontinence.
我们确定了儿童脊髓前动脉损伤后下尿路功能障碍的尿动力学模式。
在1981年至1993年间，对6名男孩和1名女孩进行了放射学、神经学和尿动力学评估。这些儿童在脐动脉插管（4例）、心血管手术（2例）以及动静脉瘘自发性出血（1例）后发生了缺血性脊髓损伤。
神经学评估显示，所有7名儿童的运动平面为T8至S1，而只有3名儿童的感觉神经支配缺失范围为T8至L4。尿动力学研究表明，3例患者表现为上运动神经元和下运动神经元混合模式，3例仅为下运动神经元损伤，1例为单纯上运动神经元缺陷。治疗方法包括5例使用奥昔布宁，1例采用克里德排尿法，1例密切观察。所有儿童均已无尿失禁，肾功能保持稳定。
儿童脊髓缺血是一种罕见的疾病，可由多种原因引起，最常见的是脐动脉插管栓塞和动脉导管未闭的手术修复。尿动力学模式各不相同，但本质上通常可为上运动神经元或下运动神经元模式。精确的检查将有助于采取适当的治疗措施，以预防上尿路疾病并尽量减少尿失禁。
