척수 손상에 기인한 방광기능 변화를 예측하는 데 있어 천수징후(Sacral Core Sign) 및 요역동학 검사의 의의
A Comparison of Level of the Injury, Sacral Cord Sign and Urodynamic Testing in the Evaluation of the Patients with Spinal Core Injury
전병규, 박정국,
소속 상세정보
전병규 ( )
고신대학교 복음병원 성형외과학교실
박정국 ( )
고려대학교
KMID : 0358319960370090996
Abstract
To define if the signs of sacral cord involvement have any predictive values in the behavior of bladder and sphincter function after spinal cord injury, we analysed results of neurologic signs and urodynamic studies from 45 patients with spinal
cord
injuries. Patients were classified based on the anatomical level (suprasacral vs. infrasacral), and the presence or absence of sacral cord sign (SCS) (bulbocavernous reflex latency time, perineal sense, anal sphincter tone). Urodynamic findings
were
classified as either detrusor hyperreflexia (DH), detrusor sphincter dyssynergia (DSD0, detrusor areflexia (DA) or normal. Results were as follows; 병원) Of the 15 suprasacral cord lesioned patients 6 (40%) had DA, of the 30 infrasacral cord
lesioned
patients 9 (20%) had either DA or DH with DSD. 대학교) SCS was positive in 16 our of 30 infrasacral, and in 대학교 의과대학 out of 15 suprasacral ocrd lesioned patients. Of the 26 SCS negative patients, suprasacral cord lesioned patients
comprised
46%.
대학교 의과대학) Of the 30 infrasacral lesioned patients, 21 had DA and 16 had positive SCS. Incidence of positive SCS in the patients with DA was 72%. 학교) Incidence of negative SCS with DH or DH+DSD was 100% in suprasacral lesion. But of the
15
suprasacral lesioned patients, 6 had DA and 대학교 의과대학 had positive SCS. 의원) In all levels of the injury, positive predictive value for the DA in positive SCS was 95%. However, negative predictive value for DA or DA+DSDD in negative SCS
was
only
62%. These results indicate that there were poor correlation between the level of the cord injury and types of urodynamic abnormalities. Also, the correlation of the SCS with anatomical level of the injury was relatively poor. Correlation of the
positive SCS with DA was very significant for both levels of the cord injury;whereas, there were poor correlation of the negative SCS with DH or DH+DSD. In conclusion, the positive SCS in itself are thought to be valuable tool in predicting
infrasacral
lesion and/or detrusor areflexia. However, the results of negative SCS may not exclude infrasacral lesion or detrusol areflexia completely. Thus, combination of the sacral cord sign and results of urodynamic evaluation will provide a more precise
diagnosis and treatment plan for the patients of spinal cord lesions.
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