| PART 1 Clinical study on symptom diversity of sacral nerve dysfunction syndrome1.1 Retrospective analysis on the correlation between sacral nerve dysfunction and spinal diseaseObjective To investigate the possible etiology?diagnosis and treatment of sacral nerve dysfunction syndrome.Methods we accepted 156 cases of non-operative patients with sacral nerve dysfunction with anal rectum and perineum discomfort as the main clinical manifestations;There were 40 cases of lumbar surgery with lumbar and lower extremity dysfunction,including 32 cases without anal rectum and perineum discomfort?11 Cases of andorectal and perineum discomfort?1 case lost.the etiology?diagnosis and treatment of sacral nerve dysfunction syndrome were retrospectively analyzed.Results A total of 159 cases were treated with anorectal and perineum discomfort,with the exception of 1 case of postoperative colon cancer and lumbar metastatic carcinoma?1 case after peritoneal tumor operation and 3 cases of lumbar multiple fractures after surgery.within the 151 non-surgical cases,138 cases had lumbar sacral intervertebral disc herniation,in which 9 cases combined with sacral cyst,2 cases of multiple cysts in the solitary sacral canal and 1 sacral nerve sheath cyst case were reported.Without lumbosacral disc herniation,10 cases were combined with lumbar intervertebral disc degeneration,fibroitis,lumbar sacral end-plate inflammation.Lumbar surgery group had 40 cases,11 cases were combined with anal rectum,perineum discomfort.Conclusion The sacral nerve disorder with major clinical manifestations of discomfort in the anal rectum,perineum,and genitourinary system are lumbar,sacral disc protrusion,denaturation,degenerative bone,vertebral slippage,sacral cyst,sacral canal and nerve occupation.position,Fiber weaving inflammation,vertebral endplate inflammation,injury and other compression or stimulation of the sacral nerve caused by a series of diseases.Treatment is based on the principle of reducing nerve compression and edema.1.2 Male urinary system discomfort manifested in 61 cases of sacral nerve dysfunctionObjective To investigate the possible etiology,diagnosis and treatment of male urinary tract discomfort as a manifestation of sacral nerve dysfunction.Methods:From October 2010 to December 2016,61 cases of sacral nerve dysfunction in male urinary tract discomfort were examined.The causes,diagnosis and treatment were analyzed retrospectively.Results within the 55 non-surgical cases,Inform the patient that the disease has little effect on health and adjust the mentality.Avoid strain and lumbar load.Stay in bed when conditions permit.Dehydration,glucocorticoid,dilatation,nutritional nerve and traditional Chinese medicine treatment.Urological discomfort improved in 16 cases with an effective rate of 29%(16/55).Urological discomfort disappeared in 15 cases.According to the cure,the cure rate was 27%(15/55).There were 19 cases that were completely invalid,and 34%(19/55)of inefficiencies were ineffective.5 cases of incomplete or missing information.Surgery group had 6 cases,L4,L5,S1 intervertebral disc removal,intervertebral bone Fusion,nail stick fixation,waist,hip,lower extremity radiolgia and genitourinary discomfort completely disappeared.Conclusion sacral nerve dysfunction patients manifested in urinary tract discomfort should be firstly informed condition and accepted psychotherapy,relieve lumbar lumbar load or relieve symptoms after bed rest.The symptoms are obviously relieved or cured after regular lumbar and sacrocyte disc herniation(dehydration,improved neuronutrition or surgery).1.3 24 Cases of functional dysfunction associated with sacral nerve dysfunction and The principle of Convergence-projection mechanism in sexual dysfunctionObjective To investigate the possible etiology,diagnosis and treatment of Sexual dysfunction as a manifestation of sacral nerve dysfunction.Methods From October 2010 to December 2016,24 patients with sacral nerve dysfunction and Urological discomfort were found to be accompanied by varying degrees of sexual dysfunction,manifested as frequent urinary frequency,inexhaustible urine,and urinary waiting combined with penis pain.21 cases of sexual dysfunction,including 11 cases of male erectile dysfunction;1 case of abnormal erection;7 cases combined waist,hip and lower extremity radiative pain;3 cases showed sustained burning pain,premature ejaculation and decreased sexual function in the testis and Glans.Results Informed the patient of the effectiveness of the disease,carry out certain psychological counseling.Avoid strain and lumbar load.Stay in bed when conditions permit.Dehydration,glucocorticoid,dilatation,nutritional nerve and traditional Chinese medicine treatment were used,Traction?physiotherapy were carried out,Some patients were treated with anglion impar?sacral nerve root?sacral canal or epidural closure treatment.There were 9 cases of erectile dysfunction and urethral pain in this group were cured,cure rate was 38%(9/24),and the degree of symptoms was reduced in 7 cases,the effective rate was 29%(7/24),and 6 cases were completely invalid.inefficient rate was 25%(6/24).2 cases were incomplete or missing.Conclusion Human sexual activity is an extremely complex physiological process.Lumbar intervertebral disc herniation can be combined or not combined with sexual dysfunction,but sexual dysfunction must be combined with lumbar intervertebral disc herniation.1.4 Analysis on the etiology,diagnosis and treatment of 41 adult refractory constipation with sacral nerve dysfunctionObjective To investigate the possible etiology,diagnosis and treatment of adult constipation as a manifestation of sacral nerve dysfunction.Methods From October 2010 to November 2017,we received 41 cases of adult constipation with sacral nerve dysfunction.All female patients had more than one natural birth history.In 39 cases,there were structural damage associated with lozosacral vertebrae,and there were no lozosacral related injuries in 2 cases,which had more than two natural childbirth.Results In 41 patients,Barium-meal colon retention films were all abnormal to varying degrees,there was a large amount of barium residue after 48 hours.The deposits of barium were all located in the left half colon and rectum.After admission to the hospital,it was recommended to avoid fatigue and lumbar load.When conditions permit,bed rest was provided.Dehydration?glucocorticoid?dilation?nutritional nerves and traditional Chinese medicine treatment were carried out.The constipation symptoms were improved and conservative treatment was effective.Conclusion sacral nerve dysfunction is one of the most important causes of intractable constipation in adultsPART 2 Efficacy of triamcinolone acetonide injection by ganglion impar block on treating sacral nerve dysfunction syndromeObjective To evaluate the efficacy of triamcinolone acetonide injection by ganglion impar block on treating sacral nerve dysfunction syndrome.Methods we accepted 54 cases of sacral nerve disorder syndrome with anal pendant expansion as the main performance from 2014 October to 2016 October in the department of General Surgery,the diagnosis and treatment were retrospectively analyzed.Results The symptoms were relieved in 15 minutes after the treatment of ganglion impar block of all the 54 patients,the pain VAS was significantly reduced after treatment.The excellent rate was 81.5%and the total efficiency was 100%in one week after surgery.In the same way,the excellent rate and the total efficiency were 90.7%and 100%in one month,94.4%and 100%in three months,83.3%and 100%in half a year.Conclusion Triamcinolone acetonide injection by ganglion impar block is significantly effective in the treatment of sacral nerve dysfunction with anal pendant expansion as the main performance.PART 3 Diagnosis,treatment and literature review of Levator Ani syndromeChronic anorectal pain is a frustrating clinical problem that comprises of at least two functional anorectal disorders that include levator ani syndrome and proctalgia fugax.sacral nerve disorder syndrome is mainly manifested in anal rectal expansion,defecation,and anal rectal pain.According to the clinical characteristics and anatomical relationship of the disease,the sacral nerve disorder syndrome and Levator Ani syndrome are discussed seem to be very similar,Or part of the sacral nerve disorder syndrome.Levator ani syndrome is a functional disorder in which recurrent or persistent distressing pain,pressure or discomfort is felt in the region of rectum,sacrum and coccyx that may be associated with the presence of pain in the gluteal region and thighs.The pain is worse on sitting and disappears on standing or lying down.Often no organic pathology is detected clinically.There is no consensus in pathophysiology.There are two hypotheses:one is a spastic or overly contracted levator ani muscle while the other is inflammation of the arcus tendon of the levator ani muscle.Anorectal manometry and balloon expulsion tests were carried out prior to the run-in and at follow-up points,Digital massage,sitz baths,muscle relaxants,electrogalvanic stimulation and biofeedback have all been reported to be effective in treatingLevator Ani syndrome,For all patients,no single treatment is particularly effective,and most require multiple ways of combination therapy or individual therapy. |
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