颈椎病与男性勃起功能障碍的临床观察

目的 对颈椎病与男性勃起功能障碍进行初步的临床研究,探讨两者间的关系.方法 对2008年3月至2009年3月手术的55岁以下男性颈椎病患者进行临床观察,患病后出现不同程度的勃起功能减退的病例共19例.对其临床特点进行初步探讨,并统计术前和术后随访时勃起功能障碍评分(IIEF-5)和JOA评分的改善率及两者相关性.结果 本组病例平均年龄48.8岁,其中12例行前路手术,7例行后路手术.随访5～18个月,平均11.8个月.所有勃起功能障碍的男性颈椎病患者术前临床及影像学上均有脊髓受压表现.IIEF-5评分为(12.1±5.6)分.术后末次随访时84.2%的病例勃起功能较术前明显改善,IIEF-5为(17.6±5.5)分,两者差异有统计学意义(P=0.002).术后勃起功能改善率平均为39.8%,而同期JOA评分改善率平均为59.3%,但相关分析显示两者间无相关性(P=0.172).另外不同的手术入路间勃起功能障碍改善率差异无统计学意义(P=0.934).结论 颈椎病脊髓压迫除了可导致常见的运动和感觉神经功能受损外,还可能与男性勃起功能障碍相关.手术减压则可能有助于改善该功能,但反应神经脊髓功能的JOA评分和勃起功能障碍评分两者的改善率没有相关性.上述结论尚待大样本研究进一步证实并深入研究其机制.

Clinical study of cervical spondylosis and male erectile dysfunction

Objective To explore the relationship between cervical spondylosis and male erectile dysfunction (ED) and to evaluate the clinical characteristics of male cervical spondylosis patients with ED. Methods Nineteen cases of male cervical spondylosis patients under 55 years old, who experienced some problems of their erectile function after the onset of cervical spondylosis, were surgically treated between March 2008 and March 2009 at our hospital. Their clinical characteristics were reviewed and clinical data prospectively analyzed. Preoperative and postoperative international index of erectile function (IIEF-5)and JOA (Japanese Orthopedic Association) scores and the correlation of improvement rate of these two scores were analyzed statistically. Results The average age of this patient group was 48. 8 years old. Twelve cases underwent anterior approach surgery while the other 7 cases posterior approach surgery. The mean follow-up period was 11.8 (5 - 18) months. All cases showed the clinical and radiological findings of spine cord compression. The preoperative and postoperative IIEF-5 scores were 12. 1 ± 5.6 and 17. 6 ± 5.5 respectively. There was obvious statistical difference between two scores (P = 0. 002). Among all patients,the erectile function of 84. 2% improved on the last follow-up. The mean improvement rate of erectile function was 39. 8% while the mean improvement rate of JOA scores 59. 3%. But there was no correlation .between these two rates (P = 0. 172). The improvement rate of erectile function showed no statistical difference between two surgical approaches (P = 0. 934) either. Conclusion Cervical spinal cord compression may be related with male erectile dysfunction besides motor and sensory dysfunctions. Surgical decompression may help to improve the erectile function. However, there is no correlation between the improvement rate of IIEF-5 scores and that of JOA scores. Future studies of a larger sample size are needed to further elucidate the underlying mechanism.