建立人工膀胱反射弧治疗脊髓损伤后弛缓性膀胱的实验研究  

EXPERIMENTAL STUDY ON THE ARTIFICIAL BLADDER REFLEX ARC ESTABLISHED IN THERAPY OF FLACCID BLADDER AFTER SPINAL CORED INJURY

作　　者：钟贵彬[1] 侯春林[1] 王诗波[1] 周晖[2] 瞿创予[3] 刘亚平[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003 [2]第二军医大学附属长征医院泌尿外科,上海200003 [3]第二军医大学附属长征医院神经内科,上海200003

出　　处：《中国修复重建外科杂志》2006年第8期812-815,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30371447)~~

摘　　要：目的探讨利用脊髓损伤平面以上健存的体反射重建人工膀胱反射弧,恢复脊髓损伤(spinalcordinjury,SCI)后膀胱排尿功能。方法1岁龄雄性Beegle犬8只,体重9.5±2.0kg。取后正中切口暴露L4～S3的棘突和椎板,全椎板切除后暴露硬膜和脊神经根,在硬膜外初步分离和确认L6和S2前根。确定犬左侧为实验侧,将左侧L6与S2前根分别在穿神经根管处切断,切开硬膜囊,从硬膜外L6和S2前根追溯硬膜内神经根,在显微镜下将L6和S2前根在硬膜内吻合。经一段时间轴突再生后,建立“膝腱-脊髓中枢-膀胱”人工反射弧。神经缝合术后8个月,在破坏S1～S4脊髓节段前后,分别进行神经电生理、膀胱肌电图及尿流动力学等远期功能观察。结果术后8个月,3只犬死亡,3只犬未能分离出吻合的神经,无实验结果。余2只犬均获得满意结果,定为1号和2号犬,进行观察。刺激(连续刺激强度200μV,刺激间隔为5ms)截瘫前和截瘫后2只犬左侧L6后根、神经吻合口,均可在吻合口远端记录到运动诱发电位,其波形和波幅相似;尿流动力学检查可见,当刺激开始时膀胱内压迅速上升,而腹内压增加幅度较小,刺激中止后膀胱内压迅速下降,证实膀胱内压升高主要是由逼尿肌收缩产生,电刺激左侧L6后根和吻合口膀胱内压升高值均可达到正常的60%左右。结论利用脊髓损伤平面以上健存的体反射重建膀胱反射通路是成功和有效的,体神经的运动支通过轴突再生能够长入自主神经的副交感神经纤维,并具有良好的传导运动兴奋的功能。Objective To establish the artificial bladder reflex arc by the normal body reflex pathway above tne horizon of spinal cord injury to reinnervate the flaccid bladder and restore bladder micturition function. Methods An intradural microanastomosis was performed on the Ls ventral root to the S2 ventral root. After axonal regeneration,the ＂patellar ligament-spinal cord center-bladder＂ reflex pathway was reestablished. A long-term function of the reflex are was observed in the nerve electrophysiologieal experiment, detrusor eleetromyography experiment, and urodynamie testing 8 months after anastomosis. Results Trains of the stimuli（200 [μV,5 ms） in the left L6 dorsal root and the nerve at the anastomosized site resulted in motor evoked potential from the disal to the anastomosized site before and after the spinal cord was destroyed horizontally between S1 and S4 segment levels in 2 Beegle dogs. The figure and amplitude of the evoked potential were similar to those of the control and general stability which showed a noninterventional wave. The urodynamie test revealed a rapid increase of the bladder pressure and a minor increase in the abdominal pressure. This showed that the bladder detrusor mainly resulted in the pressure increase. The bladder pressure increased to 60% of the normal on average compared with the controls when resulted in the left L6 dorsal root and the nerve anastomosized site were stinulated. Conclusion The long-term observation by the nerve eleetrophysiologieal experiment, detrusor eleetromyography experiment, and urodynamie test indicate that the new artificial reflex are can be established successfully. The somatic motor axons can regenerate into the parasympathetic endoneurial tubes of the autonomic nerve.

关 键 词：脊髓损伤 膀胱 反射弧 神经再支配 

分 类 号：R651.2[医药卫生—外科学] R694.5[医药卫生—临床医学]