利用膝腱反射重建膀胱功能的应用解剖研究

Applied anatomical study for the operation of bladder functional reconstruction using knee jerk reflex

目的 :为膝腱反射重建膀胱功能的手术时脊神经根和吻合平面的选择以及脊神经前根的定位提供解剖学依据。方法 :在 2 0具尸体标本上追踪股神经的脊神经根来源和相应的脊神经根的分布 ,同时观察硬膜内L2～ 4 和S2～ 4 脊神经前根排列的位置关系、相互重叠长度和横截面积。结果 :股神经主要由L3 和L4 脊神经根组成 ,L2 脊神经根的贡献较小 ;L2 和L3 脊神经根中的大部分神经纤维贡献给股神经 ,其比例显著高于L4 脊神经根。S2～ 4 前根出脊髓的平面均高于或等于L2～ 4 前根出硬膜的平面 ,L3 和L4 前根的横截面积均显著大于S2～ 4 前根横截面积。结论 :①利用膝腱反射重建膀胱功能时宜选用L3 前根与S3 或S4 前根交叉吻合。②在L1～L2 椎体平面 ,前后根的辨别和序列的确认较为容易 ,故吻合平面宜选择在脊髓圆锥处。

Objective:To provide anatomical basis for the choice of proper spin al roots,idea level of cross anastomosis and the identification of anterior spin al roots during the operation of bladder functional reconstruction using knee jerk reflex.Methods:The origins of femoral nerves,the c orresponding spinal root ′s distribution as well as L 2～4 and S 2～4 anterior roots′ overlap ping lengths ,horizontal areas and relative positions between each other were observed and me asured on 20 adult cardiveric specimens(male 14 and female 6).Result s:Femoral ne rves was composed of L 3,4 and little L 2 spinal roots;but most of L 2 an d L 3 contr ibuted to femoral nerves.The level of S 2～4 originating from spinal cord w as not lower than that of L 2～4. The transverse areas of L 3,4 anterior spin al roots wer e bigger than that of S 2～4.Conclusions:①The cros s anastomosis between L 3 anter ior spinal root and S 3 or S 4 anterior spinal root should be taken during the ope ration of bladder functional reconstruction using knee jerk reflex.②It is ea sy to distinguish the anterior spinal roots and to identify its sequence at L 1 -L 2 level,so the anastomosis should be done at conus medullaris level.