目的

探讨合并隐性脊椎裂（spina bifida occulta，SBO）的夜遗尿（nocturnal enuresis，NE）患儿影像表现与临床症状及疗效的相关性。

方法

回顾性分析2020年7月1日至2023年6月30日在中山大学附属第五医院确诊的48例合并SBO的NE患儿的影像资料、临床资料、问卷调查及排尿日记，对不同分型、分度、累及椎体数量的SBO遗尿患儿的一般情况，如性别、年龄、遗尿严重程度、有无膀胱过度活跃等方面进行比较，并探讨其相关性。

结果

不同SBO分型中，在遗尿严重程度方面，浮棘型、吻棘型以重型为主，差异有统计学意义（P＜0.05）；在治疗反应方面，吻棘型疗效最差，差异有统计学意义（P^-＜0.05）。不同分度SBO的NE患儿的临床症状及疗效，差异无统计学意义（P＞0.05）。不同受累脊椎数量中，3个脊椎受累的患儿年龄较其他2组偏大，差异有统计学意义（P＜0.05）；1个脊椎受累及2个脊椎受累治疗有效率均在85%以上，而3个脊椎受累的患儿均对治疗无反应，且差异有统计学意义（P＜0.05）。

结论

不同影像表现的合并SBO的NE患儿，临床表现及治疗效果各具特点，浮棘型、吻棘型以重型遗尿为主，而在治疗反应方面，吻棘型疗效最差；脊椎受累越多，治疗效果越差。因此在诊治合并SBO的NE患儿时应予以整体化、个体化评估和治疗。

Objective

To explore the correlation between imaging manifestations ，clinical symptoms and efficacy of Nocturnal enuresis （NE） in children with spina bifida occulta （SBO）.

Methods

From July 1， 2020 to June 30， 2023， 48 children diagnosed with NE combined with SBO in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed in terms of imaging data，questionnaire survey and urinary diaries， and the clinical data of the included children were analyzed. Two radiologists independently evaluated the SBO classification， grading， and the number of vertebrae involved based on X-ray， and scored the SBO again after an interval of 1 month. The consistency between the two radiologists and within the radiologists was evaluated by Kappa consistency test. The Chi-square test or fisher's exact test was used to explore the correlation between different types， grades， the number of involved vertebrae and the general conditions of children with SBO enuresis， such as gender， age， severity of enuresis，presence or not of overactive bladder， single symptom nocturnal enuresis， and drug treatment response.

Results

1） Among the 48 children， SBO was divided into unilateral type （27 cases）， floating spine type（17 cases） and rostral spine type （4 cases）. In terms of the severity of enuresis， the unilateral type was mainly light and medium， while the floating spine and rostral spine types were predominantly severe， with statistical difference between them （P＜0.05）. In terms of treatment response， rostral spine type had the worst effect，with statistical difference （P＜0.05）. 2） Among the 48 children with SBO， 34 cases had grade Ⅰ， 8 cases had grade Ⅱ， and 6 cases had grade Ⅲ. There were no statistical differences in clinical symptoms and treatment of NE children with different grade SBO （P＞0.05）. 3） Among the 48 children with spina bifida， 27 cases had one vertebral body involvement， 18 cases had two vertebral bodies involvement， and 3 cases had three vertebral bodies involvement. In terms of age， the children with three vertebral bodies involvement were older than the other two groups， with statistical difference （P＜0.05）. In terms of treatment response， the effective rates of one vertebral involvement and two vertebral involvement were all above 85%， while the children with three vertebral involvement did not respond to treatment， and the difference was statistically significant（P＜0.05）.

Conclusion

The clinical manifestation and therapeutic effect of NE children with SBO are different. The floating spine type and rostral spine type are dominantly characterized by severe enuresis， and rostral spine type has the worst therapeutic effect. The more involved the vertebrae， the less effective the treatment. Therefore， holistic and individual evaluation and treatment should be carried out in the diagnosis and treatment of NE children with SBO.