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[马尾神经横断伤后膀胱的功能康复]

[Functional rehabilitation of the urinary bladder after transection of cauda equina].

作者信息

Liu Z, Xu S

机构信息

Department of Orthopaedic Surgery, General Hospital of Beijing Unit, People's Liberition Army.

出版信息

Zhonghua Wai Ke Za Zhi. 1995 Dec;33(12):719-22.

PMID:8762549
Abstract

12 dogs were divided into three groups of L4 root crossover anastomosis S2 root, sacral root free anastomosis and control. All dogs received urodynamic test before and after operation and before sacrifice. The results of cystometry demonstrated the detrusor reflex had returned 7 months after operation in two groups of nerve renovation. The characteristics of axonal regeneration were revealed by immunohisto-cytochemistry and the count of nerve fibres numbers was compared with that by morphometric analysis in proximal and distal end of anastometric stoma. The comparison displayed a significant difference between nerve anastomosis groups and control group. Neural tracing study with horseradish peroxidase (HRP) in two dogs with the operation of L4 crossover S2 showed that lumbar somatic motor axons had regenerated successfully into the bladder and replaced previous sacral parasym-pathetic. Urethral sphincter function was still poor and urethral pressure was not changed post-operatively, though the electromyograme showed some improvement. The method of lumbar root or free sacral root anastomosis with sacral root is practicable for restoration of bladder function.

摘要

12只狗被分为三组,分别进行L4神经根与S2神经根交叉吻合术、骶神经根游离吻合术以及作为对照。所有的狗在手术前后及处死前均接受了尿动力学测试。膀胱测压结果显示,两组神经修复术后7个月逼尿肌反射恢复。通过免疫组织化学揭示了轴突再生的特征,并通过形态计量分析比较了吻合口近端和远端的神经纤维数量。比较显示神经吻合组与对照组之间存在显著差异。对两只接受L4与S2交叉手术的狗进行辣根过氧化物酶(HRP)神经追踪研究表明,腰躯体运动轴突已成功再生进入膀胱并取代了先前的骶副交感神经。尽管肌电图显示有一定改善,但术后尿道括约肌功能仍较差,尿道压力未改变。腰神经根或游离骶神经根与骶神经根吻合的方法对于恢复膀胱功能是可行的。

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