利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察

Clinical observations of the effects on the lower limb function after lumbar or sacral nerve root transferring to reconstruct urination function

目的观察利用正常腰骶神经根重建膀胱反射弧对切断神经根所支配区域运动功能的影响。方法对9例脊髓损伤后膀胱功能障碍而下肢运动功能仍存在的患者，利用其功能健存的脊髓节段的单根神经根前根中枢端，吻接支配膀胱的S2（或S3）神经根前根周围端，建立新的膀胱人工反射弧以重建膀胱功能，术后观察下肢相应区域运动功能变化。结果9例中4例S1神经前根切断，术后主观感觉小腿肌力稍有下降，查体踝跖屈肌力约下降半级，3个月后随访肌力恢复；2例L3神经前根切断，2例L4神经前根切断，1例L5神经前根切断，术后肌力均无明显影响。结论切断单一腰骶神经根前根对下肢运动功能无明显影响。

Objective To observe the effects on the lower limbs function after lumbar or sacral nerve root transferring to reconstruct urination function. Methods Nine patients with bladder dysfunction and normal lower limb function after spinal cord injury were treated with anastomosis the S2 or S3 nerve root with the normal lumbar or sacral nerve root to reconstruct a new bladder artificial reflex arc. Then the alterations on the sensation and motor function of the lower limb after the surgery were observed . Results Myodynamia of the legs decreased slightly, and the decreasing about half grade of the myodynamia in the plantar flexion of the ankles were detected in 4 of 9 patients with S1 transferring. And the myodynamia recovered 3 months postoperatively. No obvious decreasing of the myodynamia appeared in the other cases. Conclusion No obvious effects on the motor function can be found after the single lumbar or sacral nerve root transferring to reconstruct urination function.