摘要
为了对骶神经前根电刺激排尿神经假体和手术方法进行简化和改良 ,将 6只犬经T10 平面截瘫后 ,随机分为 2组 ,组 1完全切断两侧L7～S3 后根 ,组 2交叉组合切断两侧L7、S2 、S3 后根和S1前根 ,观察术后膀胱压力容积曲线(CMG)变化 ;另外对 10例圆锥上脊髓损伤患者 ,分别电刺激S2 、S3 和S4神经根并测定膀胱压力的变化。结果发现 ,组 2因完全打断了膀胱脊髓反射的同平面反射弧 ,其CMG曲线与切断全部后根的组 1相似 ,形成弛缓性膀胱 ;在国人 ,S3 对膀胱的支配效能占 5 2 2 % ,S4占 4 4 9% ,S2 占 2 9% ,(S3 +S4)提供了膀胱压力的 97% ,S2 无论在支配频率和支配效能方面作用均很小。提示用 1根导线携带 2个电极安放在S3～ 4神经根上 ,同时交叉切断S3～ 4后根或再加上S2 前根 ,即可获得良好的膀胱排尿和贮尿功能 ,其优点是能降低神经假体费用 。
To introduce a new modification to simplify the neuroprosthesis of sacral anterior root stimulated micturition for Chinese patients with spinal cord injury (SCI). Spinal cord was transected at T 10 in six dogs and they were randomly divided into 2 groups. In dogs of group I, bilateral L 7 ～S 3 posterior rhizotomy (complete de afferentation, SDAF) was performed. In animals of group II bilateral L 7 , S 2 , S 3 posterior rhizotomy plus bilateral S 1 anterior rhizotomy (partial de afferentation combined with partial de efferentation) were performed. Cystometrogram (CMG) was carried out weekly after the operations. For clinical studies, ten patients with complete SCI above cone were included. Intraoperative electrical stimulation of each individual S 2 ～S 4 roots was carried out and bladder pressure changes were recorded simultaneously. The results showed that the dogs in group II manifested a similar CMG to that of group I, indicating that a flaccid bladder with good compliance and storing function was resulted. For parasympathetic innervation to bladder detrusor in Chinese, it had been found that S 3 root was the most frequent (100%) and the most efficacious (52 2%) contributor, S 4 ranked the second frequent (90%) and a lesser but still significant efficacious (44 9%), and S 2 the least frequent (25%) and the minimal contributor (2 9%). It suggested that using one cable with two electrodes placed on the anterior roots of S 3 and S 4 bilaterally, combined with severance of S 3 and S 4 posterior roots as de afferentation, or plus division of anterior root of S 2 as de efferentation, could restore both voiding and storing function of the bladder in Chinese SCI patients. This new modification has the advantages of reducing the cost of neuroprosthesis and broadening of its indication
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2003年第8期670-672,共3页
Medical Journal of Chinese People's Liberation Army
基金
全军临床高新技术重大项目基金
国家自然科学基金 (编号A30 1 70 956)
上海市科技发展基金 (编号 0 2 4 4 1 90 82 )资助课题
关键词
脊髓损伤
神经假体
脊神经根
电刺激
排尿障碍
spinal cord injuries
neuroprosthesis
spinal nerve roots
electrical stimulation
urination disorders
