摘要
目的探讨胸腰椎骨折合并不完全性脊髓损伤对男性性功能的影响及其预后。方法回顾性分析2009年5月至2021年5月在北京大学第三医院创伤骨科治疗的117例胸腰椎骨折合并不完全性脊髓损伤男性患者的资料,年龄(38.6±10.6)岁(范围19~55岁),均接受后路切开复位内固定术治疗。采用国际勃起功能指数(international index of erectile function-5,IIEF-5)、早泄诊断量表(premature ejaculation diagnostic tool,PEDT)、国际脊髓损伤男性性功能基本数据库采集表评价患者性功能,根据美国脊柱损伤协会(American Spinal Injury Association,ASIA)制定的脊髓损伤分级评估患者的脊髓神经功能,观察患者伤前、伤后3个月、术后2年及末次随访时脊髓神经功能和性功能水平的变化,采用Spearman相关性分析影响伤后性功能及术后恢复的因素。结果随访时间(74.6±40.5)个月(范围26.2~161.7个月)。伤后ASIA脊髓损伤分级B级43例、C级41例、D级33例,术后2年随访时B级5例、C级19例、D级63例、E级30例,90.6%(106/117)的患者ASIA脊髓损伤分级改善,改善1级79例、改善2级27例、无变化8例、加重1级1例、加重2级2例。伤前IIEF-5评分为(19.5±6.4)分、伤后3个月为(8.7±8.0)分、术后2年为(17.5±7.1)分,差异有统计学意义(F=123.247,P<0.001);其中伤后3个月与伤前、术后2年与伤后3个月比较,差异均有统计学意义(P<0.05)。伤前PEDT评分为(5.3±3.1)分、伤后3个月为(6.9±5.2)分、术后2年为(6.4±5.1)分,差异有统计学意义(F=17.014,P<0.001);其中伤后3个月与伤前的差异有统计学意义(P<0.05)、术后2年与伤后3个月的差异无统计学意义(P>0.05)。术后2年96例IIEF-5评分恢复到伤前水平,85例PEDT评分恢复到伤前水平,83例IIEF-5分级和PEDT分级均恢复到伤前水平。伤后ASIA脊髓损伤分级与伤后3个月IIEF-5评分下降值、PEDT评分上升值呈正相关(P<0.05),受伤节段与伤后3个月IIEF-5评分下降值呈正相关(P<0.05),受伤至手术时间与伤后3个月PEDT评分上升值呈正相关(P<0.05)。伤后ASIA脊髓损伤分级与术后2年IIEF-5评分上升值呈正相关(P<0.05),受伤节段与伤后2年IIEF-5评分上升值、PEDT评分下降值呈正相关(P<0.05),受伤至手术时间与术后2年PEDT评分上升值呈正相关(P<0.05),年龄与伤后2年IIEF-5评分上升值呈正相关(P<0.05),术中是否减压与伤后2年IIEF-5评分上升值、PEDT评分下降值呈正相关(P<0.05),脊髓功能的恢复情况与伤后2年IIEF-5评分上升值、PEDT评分下降值呈正相关(P<0.05)。国际脊髓损伤男性性功能基本数据库采集表结果显示愿意讨论性问题的患者比例术后2年(47.9%)较伤后(29.9%)上升(P<0.05),心因性勃起消失和减退的患者比例术后2年(48.9%)与伤后(48.7%)的差异无统计学意义(P>0.05),反射性勃起正常的患者比例术后2年(65.0%)较伤后(34.2%)上升(P<0.05)。结论胸腰椎骨折合并不完全性脊髓损伤会导致男性勃起功能下降和早泄,且脊髓损伤程度、受伤节段部位与伤后性功能下降程度呈正相关;70.9%的患者术后2年随访时性功能恢复至伤前水平。
ObjectiveTo investigate the effects of thoracolumbar vertebral fracture with incomplete spinal cord injury on male sexual function and postoperative prognosis.MethodsA retrospective review was conducted on data from 144 male patients with thoracolumbar vertebral fractures and incomplete spinal cord injuries treated between May 2009 and May 2021 in the Department of Traumatology and Orthopedics at Peking University Third Hospital.Patients ranged in age from 19 to 55 years(mean:38.6±10.6 years)and underwent posterior incision and reduction internal fixation.The International Index of Erectile Function-5(IIEF-5),the Premature Ejaculation Diagnostic Tool(PEDT),and the International Spinal Cord Injury Male Sexual Function Basic Data Set were used for sexual function evaluation.Based on the American Spinal Injury Association(ASIA)Spinal Cord Injury classification,changes in neurological and sexual function were assessed at the pre-injury stage,3 months post-injury,2 years postoperatively,and at the final follow-up.Factors influencing sexual dysfunction and recovery were analyzed.Spearman correlation analysis was used to identify factors affecting sexual function injury and recovery.ResultsA total of 117 patients were included in the final analysis.Follow-up duration ranged from 26.2 to 161.7 months(mean:74.6±40.5 months).After injury,ASIA grades were distributed as follows:43 patients with grade B,41 with grade C,and 33 with grade D.At the 2-year follow-up,30 patients were grade E,63 grade D,19 grade C,and 5 grade B.Improvement in ASIA classification was observed in 90.6%(106/117)of patients:79 improved by one grade,27 by two grades,8 remained unchanged,1 worsened by one grade,and 2 worsened by two grades.Mean IIEF-5 scores were 19.5±6.4 pre-injury,8.7±8.0 at 3 months post-injury,and 17.5±7.1 at 2 years postoperatively,with statistically significant differences(F=123.247,P<0.001).Differences between 3 months post-injury vs.pre-injury and 2 years postoperatively vs.3 months post-injury were statistically significant(P<0.05).Mean PEDT scores were 5.3±3.1 pre-injury,6.9±5.2 at 3 months post-injury,and 6.4±5.1 at 2 years postoperatively,with statistically significant differences(F=17.014,P<0.001).The difference between 3 months post-injury and pre-injury was statistically significant(P<0.05),but not between 2 years postoperatively and 3 months post-injury(P>0.05).At the 2-year follow-up,96 patients had their IIEF-5 classification restored to pre-injury levels,85 restored PEDT classifications,and 83 restored both.Post-injury ASIA classification was positively correlated with a decrease in IIEF-5 score and an increase in PEDT score at 3 months post-injury(P<0.05).Injury segment was positively correlated with the decrease in IIEF-5 score(P<0.05).Time from injury to surgery showed a positive correlation with increased PEDT score at 3 months(P<0.05).Post-injury ASIA grade,injury segment,time to surgery,age,intraoperative decompression,and spinal cord function recovery all showed significant correlations with changes in IIEF-5 and(or)PEDT scores at 2 years postoperatively(P<0.05).According to the International Spinal Cord Injury Male Sexual Function Basic Data Set,the proportion of patients willing to discuss sexual issues increased from 29.9%at 3 months post-injury to 47.9%at 2 years postoperatively(P<0.05).The proportion of patients with absent or diminished psychogenic erections remained stable(48.7%vs.48.9%,P>0.05),while those with normal reflexive erections increased from 34.2%to 65.0%(P<0.05).ConclusionThoracolumbar fractures with incomplete spinal cord injury result in reduced erectile function and increased incidence of premature ejaculation.The degree of spinal cord injury and the level of the injured segment are strongly correlated with the extent of sexual dysfunction.At the 2-year postoperative follow-up,70.9%of patients had recovered sexual function to pre-injury levels.
作者
司高
王悦心
胡道乐
侯国进
杨钟玮
郭琰
张志山
姬洪全
周方
田耘
吕扬
Si Gao;Wang Yuexin;Hu Daole;Hou Guojin;Yang Zhongwei;Guo Yan;Zhang Zhishan;Ji Hongquan;Zhou Fang;Tian Yun;Lyu Yang(Peking University Third Hospital,Department of Orthopaedics(Engineering Research Center of Bone and Joint Precision Medicine),Beijing 100191,China;Third School of Clinical Medicine,Peking University,Beijing 100191,China)
出处
《中华骨科杂志》
北大核心
2025年第9期552-560,共9页
Chinese Journal of Orthopaedics
关键词
胸椎
腰椎
脊柱骨折
脊髓损伤
勃起功能障碍
早泄
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Spinal cord injuries
Erectile dysfunction
Premature ejaculation
