硬膜外转移 S2 和 S3 腹根到 S1 腹根用于恢复脊髓损伤后神经性膀胱的解剖学可行性。

Anatomical Feasibility of Extradural Transferring S2 and S3 Ventral Roots to S1 Ventral Root for Restoring Neurogenic Bladder in Spinal Cord Injury.

机构信息

Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.

出版信息

Spine (Phila Pa 1976). 2018 Sep 15;43(18):E1046-E1052. doi: 10.1097/BRS.0000000000002613.

DOI:10.1097/BRS.0000000000002613

PMID:29470276

Abstract

STUDY DESIGN

Anatomic study in six formalin-fixed cadavers.

OBJECTIVE

To determine the anatomical feasibility of transferring the S2 and S3 ventral roots (VRs) to S1 VR as a method for restoring bladder dysfunction in spinal cord injury.

SUMMARY OF BACKGROUND DATA

A large quantity of researches of neuroanastomosis methods have been used for treating the bladder dysfunction in spinal cord injury. However, some limitations retard the development of those studies.

METHODS

In this study, six formalin-fixed cadavers (four males, two females) were dissected. The feasibility of exposing the S1, S2, and S3 extradural nerve roots by the limited laminectomy, isolating the VR and dorsal roots from each extradural nerve root and transferring the S2,S3 VRs to the S1 VR were assessed. The pertinent distances and the nerve cross-sectional areas in each specimen were measured. The morphology of each nerve root was observed by hematoxylin-eosin staining.

RESULTS

The limited laminectomy was performed to expose the S1 to S3 extradural nerve roots. The VRs could be isolated from each extradural nerve root at the location of the dorsal root ganglion and the hematoxylin-eosin staining showed that there were some connective tissues separating the VRs from the corresponding dorsal root ganglion. The S2 and S3 VRs have sufficient lengths to be transferred to S1 VR without grafting. The mean cross-sectional area of the S1 VR was 2.60 ± 0.17 mm, and that was 1.02 ± 0.32 mm and 0.51 ± 0.21 mm of the S2 and S3 VRs, respectively.

CONCLUSION

This study demonstrated that use of the S2 and S3 VRs for extradural transfer to S1 VR for restoring bladder dysfunction is surgically feasible.

LEVEL OF EVIDENCE

摘要

研究设计

在 6 具福尔马林固定的尸体上进行解剖学研究。

目的

确定将 S2 和 S3 腹根（VR）转移到 S1 VR 作为恢复脊髓损伤后膀胱功能障碍的方法的解剖学可行性。

背景资料概要

大量的神经吻合方法研究已被用于治疗脊髓损伤后的膀胱功能障碍。然而，一些局限性阻碍了这些研究的发展。

方法

在这项研究中，对 6 具福尔马林固定的尸体（4 名男性，2 名女性）进行了解剖。通过有限的椎板切除术暴露 S1、S2 和 S3 硬膜外神经根的可行性、从每个硬膜外神经根分离 VR 和背根，并将 S2、S3 VR 转移到 S1 VR 的可行性进行了评估。测量了每个标本中的相关距离和神经横截面积。通过苏木精-伊红染色观察每个神经根的形态。

结果

进行有限的椎板切除术以暴露 S1 至 S3 硬膜外神经根。VR 可以在背根神经节处从每个硬膜外神经根分离出来，苏木精-伊红染色显示，有一些结缔组织将 VR 与相应的背根神经节隔开。S2 和 S3 VR 有足够的长度可以转移到 S1 VR 而无需移植。S1 VR 的平均横截面积为 2.60±0.17mm，而 S2 和 S3 VR 的横截面积分别为 1.02±0.32mm 和 0.51±0.21mm。