人工膀胱反射弧重建治疗脊髓损伤后弛缓性膀胱  

Experimental and clinical study on the artificial bladder reflex arc re-establishment in therapy of flaccid bladder after spinal cord injury

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

机构地区：[1]第二军医大学长征医院骨科,上海市200003

出　　处：《中国脊柱脊髓杂志》2007年第10期781-784,I0004,共5页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金(30371447)

摘　　要：目的:探索利用截瘫平面以上正常的体反射重建膀胱反射弧,恢复脊髓损伤后弛缓性膀胱排尿功能的可行性。方法:将Beagle犬L6前根近端与S2前根远端在硬膜内显微吻合,经一段时间的轴突再生后,建立"膝腱-脊髓中枢-膀胱"人工反射弧,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和辣根过氧化物酶(HRP)逆行示踪等检查:对1例L1压缩性骨折伴截瘫患者行右侧T11与S2前根经腓肠神经移植硬膜内吻合术。结果:2只犬在术后8个月时电刺激截瘫前和截瘫后左侧L6后根、神经吻合口近端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,当刺激开始时逼尿肌压力和膀胱内压均迅速上升,而腹内压增加幅度较小,刺激中止后膀胱内压迅速下降;膀胱注射HRP后48h实验侧L6脊髓节段前角中发现HRP标记的大神经元细胞。临床1例患者术后55个月时随访,膀胱充盈后可产生自控性排尿,尿流动力学显示排尿完全是由膀胱逼尿肌的收缩引发。结论:利用截瘫平面以上正常的体反射建立人工反射弧通路是成功和有效的,可恢复脊髓损伤后弛缓性膀胱自控性排尿。Objective：To re-establishment the artificial bladder reflex arc with the normal body reflex pathway above the horizon of spinal cord injury（SCI） to reinnervate the flaccid bladder and restore bladder micturition function.Method：h was achieved by intradural microanastomosis of the L6 ventral root to S2 ventral root.Mter axonal regeneration,the ＂patellar ligament-spinal cord center-bladder＂ reflex pathway was reestablished.The function of the reflex arc was observed by nerve electrophysiological experiment,detrusor electromyography experiment,urodynamic testing and HRP retrograde tracing before and in 8 months after the spinal cord was destroyed horizonally between S1 and S4 level.There was one case of conical SCI patient who had L1 fracture and paraplegia was received intradural of the L6 ventral root to S2 ventral root after L1 fracture and paraplegia.Result：Electric stimuli at the left L6 dorsal root and nerve anastomosized site could result in a motor evoked potential at the point distal to the anastomosized site before and after the spinal cord was destroyed horizontally between S1 and S4 segment level in two Beagle dogs.The figure and ampulitude of the motor evoked potential were similar to the control and general stability.Urodynamic testing display quick increase of the bladder pressure and minor raise in abdominal pressure.This manisfested that bladder detrusor mainly contributed pressure rising.There were HRP labeled cells in L6 ventral horn on the experimental sides.Stimulation of the new artificial reflex arc could induce controlled voiding and cause detrusor contraction was demonstrated in the patient after 55 months of follow-up.Conclusion：The re-establishment of artificial bladder reflex arc by the normal body reflex pathway above the horizon of spinal cord injury had been established successfully and effectively.

关 键 词：脊髓损伤 膀胱 反射弧 神经再支配 排尿 

分 类 号：R683.2[医药卫生—骨科学] R694[医药卫生—外科学]