主題： 脊髓損傷者肛門外括約肌肌電圖評估與應用之研究脊髓損傷後導致患者排尿困難，導因於膀胱與尿道括約肌功能的改變，包括：膀胱逼尿肌反射性收縮過強，逼尿肌–尿道外括約肌共濟失調(detrusor-external sphincter dyssynergia, DESD)，膀胱順應性降低等，均易造成膀胱內壓上升，排尿阻力增加。DESD與脊髓損傷部位、完全性損傷、上尿路併發症均有相關，不同類型的DESD，對尿道排尿阻力產生不同的影響。逼尿肌-尿道外括約肌共濟失調，目前均以尿道外括約肌肌電圖 (urethral sphincter electromyogram)來判讀，但是因為骨盆底肌肉的痙攣性收縮，易造成尿道外括約肌肌電反應的混淆；且尿道外括約肌位於體內深部，無法經由肉眼辨識，這兩項因素經常導致記錄電極的定位錯誤。有研究顯示，脊髓損傷患者在肛門括約肌與直腸的生理變化，類似膀胱逼尿肌與尿道外括約肌在尿路動力學上的變化。因此本研究將以脊髓損傷後合併神經性膀胱障礙的患者為研究對象，在接受錄影尿路動力學檢查與尿道外括約肌肌電圖檢查時，同時紀錄肛門外括約肌肌電圖(anal sphincter electromyogram)。由於肛門外括約肌屬於表淺肌肉層，可以輕易由肉眼辨識定位，且因為該肌肉組織豐厚，適用於量化肌電圖(quantitative EMG)的分析。本研究的目的，在於以量化肌電圖分析肛門外括約肌肌電圖的肌電表現，探討肛門外括約肌肌電圖不同類型與排尿障礙之間的相關及其影響程度；並探討肛門外括約肌與尿道外括約肌，兩者在肌電圖反應的程度與相關性。藉此研究來探討肛門外括約肌肌電圖，在脊髓損傷者排尿障礙方面的運用範圍與應用價值，以作為臨床評估的參考。
Evaluation and utilization of anal sphincter electromyography in subjects with spinal cord injury Urologic complications have been the major source of morbidity and mortality among patients with spinal cord injury (SCI). Improvements in urologic care may be credited for the improved survival among SCI patients. Injury to the spinal cord occurs above the conus medullaris, detrusor hyperreflexia with the detrusor-external sphincter dyssynergia (DESD) commonly develops. The correlation of DESD subtypes with urologic complications and clinical characters, such as the level of cord lesion, completeness of injury, and the effect on the urethral pressure, has been widely investigated. Anorectal dyssynergy may demonstrate similarities to that seen in the bladder following SCI. Therefore, the patterns of anorectal manometry seen were similar to those in cystometrogram in SCI patients. The identification of DESD is based on the accurate localization of recording electrode into the urethral sphincter during video urodynamic study was performed. Due to coexistent spasticity of pelvic floor muscles and difficulty in making the sphincter visible direct, the placement of electrodes is usually improper in case of EMG guide alone. So we conduct this study to evaluate the utilization of anal sphincter electromyogram in SCI patients with voiding dysfunction, and to identify a relationship between urethral and anal sphincters.
