骶神经根电刺激排尿中完全性后根去传入的替代方法

An alternative procedure to complete posterior deafferentation in sacral anterior root stimulation for controlled micturition in spinal cord injuries

目的 探讨脊髓损伤病人进行骶神经根电刺激排尿时膀胱完全性去传入手术的替代方法。方法 10条犬经T10 平面截瘫后 ,按L7～S3 前后根切断程度和组合方式的不同分成 4组 ,观察术中神经根电刺激时膀胱尿道的压力变化和术后膀胱压力容积曲线 (CMG)变化。结果 保留 2侧S1前后根完整 ,电刺激同平面S1的总根或后根 ,膀胱尿道的压力反应相同 ;切断两侧S1前根 ,刺激同平面的S1后根 ,膀胱尿道的压力反应显著降低 ,仅为前后根完整时的 7%～ 12 %。保留同平面S1前后根的完整 ,其CMG曲线与完全不切断时的对照组相似 ,形成痉挛性膀胱 ;切断S1前根 ,其CMG曲线与切断全部后根的对照组相似 ,形成弛缓性膀胱。结论 不同平面的骶神经前后根组合切断 ,能获得与完全性后根切断相同的膀胱去神经效果。

Objective To develop a new alternative procedure to complete posterior deafferentation of bladder for sacral anterior root stimulated micturition in spinal cord injuries.Methods Ten T 10 spinal cord transected dogs were divided into 4 groups according to different extents and combination of L 7~S 3 anterior and posterior rhizotomy to observe the changes in bladder and urethral pressure during nerve root electrostimulation and in cystometrogram (CMG) after operation. Results Preserving bilateral S 1 anterior and posterior roots intact combined with rhizotomies of L 7 and S 2~3 posterior roots, intradural stimulation of S 1 posterior root producedan increase of bladder and urethral pressure similar to that of stimulation of the S 1 common root in extradural. However, rhizotomy of bilateral L 7 and S 2~3 posterior roots followed by S 1 anterior root, stimulation of S 1 posterior root only produced a significant decrease of pressure (only 7% to 12% of that in anterior and posterior root intact ) in bladder and urethral. In preserving S 1 anterior and posterior root intact combined with L 7 and S 2~3 posterior rhizotomies, CMG was similar to that of the free group,forming a spastic bladder. In rhizotomy of S 1 anterior root combined with L 7 and S 2~3 posterior roots, CMG was similar to that of the complete L 7 to S 3 posterior rhizotomy group, forming a flaccid bladder.Conclusion Combined rhizotomy of anterior and posterior sacral roots in different levels has the same denervative effects on bladder as complete posterior deafferentation.