长时间电刺激后骶神经根的结构观察及临床意义  

Structure observation and clinical significance of sacral roots after long term electric stimulation in dogs

作　　者：王诗波[1] 侯春林[1] 雷波[2] 张世民[1] 刁颖敏[2] 张伟[1] 陈爱民[1] 尹承慧[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海市200003 [2]同济大学生命科学与技术学院

出　　处：《中华显微外科杂志》2004年第4期268-270,i003,共4页Chinese Journal of Microsurgery

基　　金：总后临床高新技术重大项目基金 ;国家自然科学基金(30 1 70 956);上海市科技发展基金 (0 2 4 4 1 90 82 )

摘　　要：目的　观察长时间电刺激后骶神经根的结构变化 ,从而评价自制膀胱控制器植入术的安全性和远期疗效。　方法　 4只T10 平面截瘫犬在双侧S2 神经根上植入膀胱控制器的刺激电极 ,在实验结束前对截瘫犬进行连续电刺激 ,达到一定的累积刺激时间后取S2 神经根进行光镜和电镜检查 ,观察长时间的电刺激对犬骶神经根有无损伤。　结果　最长的累积刺激时间达 162h时 ,光镜显示骶神经前根结构无明显变化 ,后根神经纤维变性 ,骶神经根周围纤维结缔组织增生。电镜显示神经轴突正常 ,部分髓鞘有松散 ,粗面内质网和胶元分泌旺盛 ,提示纤维细胞增生。　结论　自制膀胱控制器长期使用是安全和有效的。但是电镜下部分有髓神经纤维的髓鞘有松散仍应引起我们的注意。在使用膀胱控制器刺激排尿时 ,在达到尿液排空的目的后 ,排尿应尽可能选择低电压和低频率的电刺激模式 ,减小对骶神经根的刺激强度。Objective To evaluate the long term results and security of bladder controller implantation through observing the structure of sacral roots after a long time electric stimulation Methods Four dogs were included in this study after their spinal cord were transected above the cone Electrodes were implanted around S 2 bilaterally Paraplegic dogs were stimulated continuously before the end of the experiments S 2 nerve roots bilaterally were cut for histological and ultrastructure examination to observe whether the stimulated nerve roots were damaged or not after a cumulated time of 150 h each Results Light microscopic examination indicated the structure of ventral roots of sacral nerve hadn’t apparent degeneration after a cumulated stimulation time of 162 h The nerve fibers of dorsal roots was degeneration and nerve was embedded in fiber connective tissue The ultrastructure of axon was normal, a little segment of the myelin sheath was loose, rough endoplasmic reticulum and collagen secreted actively, this indicated fibroblast hyperplasia Conclusions Long term application of bladder controller is safe and effective But we should be alert to the loose myelin sheath under ultrastructure The micturition mode of low voltage and low frequency should be selected to decrease stimulation intensity of sacral roots when the objective of urine evacuation was achieved [Key words] Spinal cord injury; Electric stimulation; Sacral roots; Ultrastructure

关 键 词：骶神经根 电刺激 膀胱控制器 观察 截瘫 髓鞘 增生 累积 变性 内质网 

分 类 号：R651.2[医药卫生—外科学]