肋间神经转位与骶2神经根吻合或经腓肠神经移植体与阴部神经吻合重建截瘫犬膀胱功能  

Reconstruction of bladder functions in paraplegic dogs by vascularized intercostal nerves tranferring to S2 nerve roots or to pundendal nerves through sural nerve graft

作　　者：曹述铁[1] 申小青[2] 韩伟[1] 柳洁[1] 胡祥上[1] 贺显玉[1] 易传安[1] 张绪华[2] 尹立[1] 

机构地区：[1]怀化医学高等专科学校 [2]怀化医学高等专科学校附属医院,怀化418000

出　　处：《解剖学杂志》2008年第4期575-578,共4页Chinese Journal of Anatomy

基　　金：湖南省教育厅科学技术研究项目(03C040)

摘　　要：目的:评价带血管肋间神经转位与骶2神经根吻合、自体腓肠神经桥接阴部神经重建截瘫犬膀胱功能的可行性。方法:犬均经第1腰髓平面损伤造成截瘫,随机分为3组,带血管肋间神经转位与骶2神经根吻合组、带血管肋间神经转位自体腓肠神经桥接阴部神经组和对照组。观测犬术前、后膀胱压力/容积、残余尿量和肛门括约肌肌电图,并分别于术后3、6和12个月处死动物,在光镜下观察移植部位的神经再生情况。结果:犬术前膀胱压力/容积平均为71 cmH2O/150 ml、肛门反射灵敏、肛门括约肌肌电图为(140±5)μV;术后6个月,吻合组、桥接组膀胱压力/容积分别为55 cmH2O/280 ml、50cmH2O/300 ml;12个月分别为65 cmH2O/280 ml、62 cmH2O/280 ml;术后6个月吻合组、桥接组肛门括约肌肌电图平均为(50±5)μV;12个月平均为(100±6)μV。术后3个月,吻合组、桥接组可见部分神经纤维跨过吻合桥接部位;12个月神经纤维完全通过吻合桥接部位。结论:带血管肋间神经转位与骶2神经根吻合、自体腓肠神经桥接阴部神经重建截瘫犬膀胱功能是可行的。Objective, To evaluate the feasibility of functional reconstruction of bladder in paraplegic dogs by vascularized in- tercostal nerves tranferring to S2 nerve roots or transferring to pundental nerves through sural nerve graft. Methods： Ten dogs were divided into three groups randomly. Spinal cord in all the dogs was transected at the first lumbar vertebra. Four dogs in one group were operated by the method of vascularized intercostal nerves transferring to S2 nerve roots. And four dogs in another group were operated by the method of vasularized intercostal nerves transferring to pundendal nerves serving as a bridge to connect sural nerve. Two dogs worked as the control. The bladder pressure/volume, residual urine volume and micturition and electromyogram of sphincter anus in all dogs were observed and measured before and after the operation. The dogs were persecuted three, six, and twelve months after the operation, being used to observe nerve regeneration under light microscope. Results： The mean pressure/volume of the ten dogs was 71 cmH2O/150 ml. Before the operation, all the dogs anus had acute reflection, and their electromyogram of sphincter anus were （140±5）/,V; Six months later, the mean bladder pressure/volume of the S2 nerve roots connecting group and the bridge grafting group was 55 cmH2O/280 ml and 50 cmH2O/300 ml respectively; Twelve months later, the mean bladder volume pressure was 65 cmH2O/280 ml and 62 cmH2O/280 ml respectively; Six months later, the average electromyogram of the sphicter anus of the S2 nerve roots con- necting group and the bridge grafting group was （50± 5）/,V; Twelvg months later, （100 ± 5） t,V. Six months later, the number of myelin sheaths and axons increased, and a fraction of nerve fibres were seen cross the connecting point; Twelve months later, nerve fibres went through the connecting part totally. Conclusion： It is feasible to reconstruct bladder functions in paraplegic dogs by the method of vascularized intercostal nerves transferring to S2 nerve r

关 键 词：膀胱功能 脊髓损伤 截瘫 肋间神经 神经转位 神经移植体 

分 类 号：R651.3[医药卫生—外科学]