Pontari M A, Bauer S B, Hall J E, Emans J B
Children's Hospital, Boston, MA 02115, USA.
J Pediatr Orthop. 1998 Nov-Dec;18(6):820-3.
Four children with thoracic level paraplegia and severe myelokyphosis underwent distal spinal cord resection at the time of kyphectomy. All four children were continent before spinal cord resection and became incontinent immediately afterward. Two children in retrospect had preoperative urodynamics that showed intact innervation to the external sphincter, and two had no preoperative urodynamic studies. All four had evidence of lower urinary tract denervation on urodynamic studies performed after cord resection. The urologic and urodynamic consequences of spinal cord resection at the time of kyphectomy in children with myelodysplasia are reviewed. Resection of the distal spinal cord in thoracic level myelodysplasia may cause postoperative incontinence in some previously continent patients. Preoperative urodynamic evaluation and urologic consultation is recommended. If individual evaluation indicates that residual sacral function is beneficial to urologic management, kyphectomy without cord resection is preferable.
四名患有胸段截瘫和严重脊髓后凸畸形的儿童在进行后凸畸形切除手术时接受了脊髓远端切除术。所有四名儿童在脊髓切除术前均能自主控制排尿，术后立即出现尿失禁。回顾性分析发现，两名儿童术前尿动力学检查显示外括约肌神经支配完整，另外两名儿童未进行术前尿动力学检查。所有四名儿童在脊髓切除术后进行的尿动力学检查中均有下尿路去神经的证据。本文对脊髓发育不良儿童在进行后凸畸形切除手术时切除脊髓的泌尿学和尿动力学后果进行了综述。胸段脊髓发育不良患者进行脊髓远端切除可能会导致一些术前能自主控制排尿的患者术后出现尿失禁。建议进行术前尿动力学评估和泌尿学咨询。如果个体评估表明残留的骶骨功能对泌尿学管理有益，那么不进行脊髓切除的后凸畸形切除术更为可取。
