正常S_1神经作为动力神经切断后对下肢功能的远期影响  

LONG-TERM EFFECTS ON LOWER LIMB FUNCTION AFTER S_1 NERVE ROOT TRANSECTION AS DYNAMIC SOURCE

作　　者：雷德桥 侯春林[1] 赵建国[1] 林浩东[1] 

机构地区：[1]第二军医大学附属上海长征医院骨科,上海200003

出　　处：《中国修复重建外科杂志》2015年第7期849-852,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 评价正常S1神经根作为动力神经切断后对下肢功能的远期影响。方法 2007年1月-2011年12月收治行S1神经根移位重建膀胱功能手术的脊髓圆锥损伤后膀胱功能障碍患者47例。男43例,女4例;年龄22～66岁,平均40.7岁。脊椎骨折部位：L133例,L25例,L32例,T12、L13例,L1、L21例,L1、L31例,L1、L41例,L2、L31例。脊髓损伤后4～24个月,平均8个月行S1神经根移位重建膀胱功能手术。术前尿流动力学均显示弛缓性膀胱;下肢屈屈踝肌力4级5例,5级42例。结果 术后第2天检查屈屈踝肌力,31例与术前肌力水平一致,16例神经切断侧相关肌力轻微下降约半级。47例均获随访,随访时间3～8年,平均5.1年。术后2周行神经电生理检查,大部分患者表现有神经源性损害,其中19例出现术侧胫神经最大波幅降低,13例术侧腓总神经最大波幅降低,9例术侧胫神经、腓总神经最大波幅均降低。除术后2周术侧腓总神经潜伏期与术前比较差异无统计学意义（t=—1.881,P=0.093）外,其余各神经电生理指标手术前后比较差异均有统计学意义（P〈0.05）。随访期间未见下肢屈屈踝肌力减退,行走能力较术前均无下降。结论 S1神经切断后对下肢功能无明显影响,S1神经可作为安全的动力神经用于下肢功能重建。Objective To evaluate the long-term effects on the lower limb function after S1 nerve root transection as dynamic source. Methods Between January 2007 and December 2011, 47 patients with atonic bladder dysfunction underwent S1 nerve root transposition to reconstrut the bladder function. There were 43 males and 4 females, with an average age of 40.7 years（range, 22-66 years）. The locations were L1 in 33 cases, L2 in 5 cases, L3 in 2 cases, T12, L1 in 3 cases,L1, L2 in 1 case, L1, L3 in 1 case, L1, L4 in 1 case, and L2, L3 in 1 case. The anastomosis of the S2 or S3 nerve root to S1 nerve root was performed from 4 to 24 months（mean, 8 months） after spinal cord injury. The strength of ankle plantar flexion was grade 4 in 5 cases and grade 5 in 42 cases before operation. Results The strength of ankle plantar flexion had no obvious decrease（grade 4 or 5） in 31 cases, reduced 0.5 grade in 16 cases at 2 days after operation. All the patients were followed up 3-8 years（mean, 5.1 years）. At 2 weeks after operation, the nerve electrophysiological examination showed neurogenic damage at operated side in most patients, including reduced amplitude tibial nerve in 19 cases, for common peroneal nerve in 13 cases, and for tibial nerve and common peroneal nerve in 9 cases. Except the velocity of common peroneal nerve（t= —1.881, P=0.093）, the other electric physiological indexes showed significant differences between at pre- and postoperation（P〈0.05）. The muscle strength basically recovered to preoperative level（grade 4 or 5） during follow-up, and there was no impairment of lower limb function. Conclusion S1 transection has no significant effects on lower limb function,so S1 nerve can be used as dynamic nerve for nerve function reconstruction.

关 键 词：S1神经 动力神经 下肢功能 功能重建 

分 类 号：R651.2[医药卫生—外科学]