脊髓损伤后弛缓性膀胱生理排尿反射弧重建的实验研究  

EXPERIMENTAL STUDY ON ESTABLISHMENT OF PHYSIOLOGICAL MICTURITION REFLEX ARC FOR ATONIC BLADDER AFTER SPINAL CORD INJURY

作　　者：马军 朱裕成 朱爱祥 卫中庆[2] 曹晓建[3] 

机构地区：[1]南京鼓楼医院集团宿辽市人民医院骨科,江苏宿迁223800 [2]南京医科大学附属第二医院泌尿外科 [3]江苏省人民医院骨科

出　　处：《中国修复重建外科杂志》2010年第11期1361-1366,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：江苏省科技厅社会发展计划项目(BS2007044)~~

摘　　要：目的探讨脊髓损伤(spinal cord injury,SCI)后同时重建膀胱的感觉和运动神经恢复膀胱生理排尿功能的可行性。方法 8只1岁龄雄性Beegle犬,体重7～12kg,以左侧为实验侧、右侧为对照侧。于椎管内硬膜外将实验侧L7前根中枢端与S2前根远端、L7后根中枢端与S2后根远端分别吻合,同时重建膀胱感觉与运动功能;对照侧不作任何处理。术后经12个月神经再生后,锐性毁损S1～4节段脊髓制备完全性截瘫模型,于截瘫前、后分别进行膀胱内压(串刺激参数为强度300mV、脉冲宽度0.3ms、刺激频率20Hz,持续5s)和神经电生理(单刺激参数为强度300mV、间期0.3ms)测定。截瘫后饲养3个月,观察动物排尿情况。处死后取吻合节段神经根观察神经生长情况。结果 8只Beegle犬存活7只。截瘫后连续观察3个月,犬最初呈尿失禁,尿频淋漓,1个月后渐能控制排尿,排尿间期无尿频淋漓。3个月内3只存活犬有不同程度尿路感染,服用诺氟沙星1～3次控制感染。截瘫前、后实验侧S2后根膀胱内压升高为(1.00±0.13)kPa和(0.90±0.12)kPa,差异无统计学意义(P>0.05);截瘫前对照侧S2后根膀胱内压升高为(1.90±0.10)kPa,明显高于实验侧截瘫前、后膀胱内压(P<0.01)。截瘫前、后实验侧均能在S2前根记录到动作电位,其波形和波幅相似,波幅分别为(0.68±0.11)mV和(0.60±0.08)mV,差异无统计学意义(P>0.05);截瘫前在对照侧S2前根记录到的动作电位波形与截瘫前实验侧相似,但波幅(1.21±0.13)mV明显高于截瘫前、后实验侧波幅(P<0.01)。组织学观察示L7前、后根的神经纤维均已通过吻合口部长入S2神经前、后根。结论犬SCI平面以下的骶神经前、后根与损伤平面以上健存的神经前、后根分别吻合,可以重建膀胱的生理排尿反射弧,恢复SCI后弛缓性膀胱的自主排尿功能。Objective To investigate the feasibility of establishment of physiological micturition reflex arc by simultaneously reconstructing the sensory and the motorial nerve of atonic bladder after spinal cord injury.Methods Eight 1-year-old Beegle male canine were selected,weighing 7-12 kg.The left side was the experimental side,while the right side was the control side.Epidural microanastomosis of vertebral canal of the left L7 ventral root to S2 ventral root and L7 dorsal root to S2 dorsal root was performed to reconstruct the sensory and the motorial function of atomic bladder.The right side was used as a control without treatment.The new motor-to-motor,and sensory-to-sensory physiological bladder reflex pathway were established after 12 months of axonal regeneration.Then S1-4 segmental spinal cord was destroyed for preparation of complete paraplegia.The electrophysiological examination and the bladder pressure were detected before and after paraplegia.The canine micturition was observed for 3 months after paraplegia.Nurohistological observation was performed after canine sacrifice.Results Of 8 canine,7 canine survived.After paraplegia,canines displayed urinary incontinence and frequent micturition at first,nocturnal continence was achieved gradually without frequent micturition after 1 month.Urinary infection at different degrees occurred in 3 canines and was controlled after Norfloxacin was administered orally.The bladder pressure increased to（1.00 ± 0.13） kPa,（0.90 ± 0.12） kPa after trains of stimulation（300 mV,0.3 ms,20 Hz,5 seconds） of S2 dorsal root at the experimental side before and after paraplegia respectively,showing no significant difference（P 0.05）.It increased to（1.90 ± 0.10） kPa after the same train of stimulation of S2 dorsal root at control side.There was significant difference between the experimental side and the control side（P 0.01）.Single stimulation（300 mV,0.3 ms） of the S2 dorsal root at the experimental side resulted in evoked potentials recorded from the left S2

关 键 词：脊髓损伤 弛缓性膀胱 生理反射弧 神经根吻合 犬 

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