摘要
目的 通过建立家犬人工膀胱反射弧,以恢复脊髓损伤后的膀胱功能。它包含一个体反射弧,并将体反射运动冲动经异化的运动传出支传入膀胱,引起膀胱的自主性收缩。方法 将右L5 前根近端与右S2 前根远端在硬膜囊内行显微吻合,保持L5 后根完整,经轴突再生后,建立膝腱—脊髓中枢—膀胱这一新的人工反射通路,通过刺激右侧膝腱激发排尿。神经根吻合术后6 个月和18 个月,分别进行神经电生理、膀胱测压、膀胱逼尿肌肌电图等早期和远期功能观察。结果 T10 椎管平面截瘫前后,单相方波(115 m V,1-0 ms) 刺激右L5 后根,6 只犬均可在吻合口远端记录到动作电位,其形态和波幅与对照组相似;4 只犬术后6 个月截瘫48 小时后,串刺激(1000 mV,10 Hz,2 s)右L5 后根,经新建的反射弧引出的膀胱收缩平均可达正常对照组的65% ,敲击右侧膝腱引出的膀胱收缩平均达正常的51 % ;2 只犬术后18 个月,相同电流刺激引出的膀胱收缩平均达正常的84% ,敲击膝腱平均达62 % ;电刺激(3-8 m A,1-0 Hz)右L5 后根和右股神经,2 只犬均可记录到膀胱逼尿肌肌电图,其形态和波幅与对照组相似。结论 体神经的运动传出支通过轴突再生能够长入自主神经的副交感性纤维,并具有良好的传导运动兴奋的功能;利用截瘫平面以下健存的体反射。
Objective\ To establish an artificial bladder reflex arc in canines to reinnervate the neuropathic bladder and restore bladder function after spinal cord injury.It involves a somatic reflex arc with a modified efferent branch which passes the somatic motor impulses to the bladder and initiates autonomic bladder detrusor contraction.Methods\ Intradural microanastomosis of the right L 5 ventral root to S 2 ventral root was performed to maintain the right L 5 dorsal root intact.After axonal regeneration,the new patellar ligament spinal cord center bladder artificial bladder reflex pathway was established,and micturition was induced by knocking the patellar ligament.The early and final function of the reflex arc was observed by electrophysiological examinations, bladder pressure tests and detrusor electromyograms(EMG)at 6 months and 18 months postoperatively.Results\ Single stimuli (115 mV, 1.0 ms)of the right L 5 dorsal root resulted in evoked potentials recorded from the right S 2 ventral root distal to the anastomosized site before and after the spinal cord was transected horizontally at the T 10 segment level in all 6 canines.Bladder contraction was very quickly initiated by trains of stimuli(1 000 mV,10 Hz,2 s)of the right L 5 dorsal root and bladder pressures increased rapidly to 65% of normal, and bladder contraction induced by knocking the right patellar ligament was increased to 51% of normal through the new reflex arc in 4 canines after 6 months of operation.Bladder pressures were increased by the same stimuli to average 84% of normal and to 62% of normal by knocking the patellar ligament in 2 canines after 18 months of operation. Stimuli(3.8 mA,1.0 Hz) of the right L 5 dorsal root and femoral nerve resulted in EMG similar to normal EMG could be recorded from the detrusor in 2 canines after 18 months postoperatively.Conclusion\ The somatic motor axons can be regenerated into the parasympathetic endoneurial tubes of autonomic nerve.Using the survived somatic reflex under the horizon of spinal cord injury to reconstruct the bladder autonomic reflex arc by intradural microanastomosis of ventral root is practical in the canine model and may have a potential of clinical application.
出处
《中国修复重建外科杂志》
CAS
CSCD
2000年第1期10-13,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
膀胱功能
脊髓损伤
反射弧
Bladder function\ \ Reflex\ \ Spinal cord injury
