利用下腹壁反射重建膀胱功能的应用解剖学研究

Applied anatomic study on the operation of bladder functional reconstruction with lower abdominal reflexes

目的 :为下腹壁反射重建膀胱功能手术时脊神经前根和吻接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具成人尸体标本上观察了硬膜内T11、T12 和S2～ 4脊神经前根排列的位置关系、相互的距离和横截面积。结果 :(1)脊神经前根横截面积T11(0 .70± 0 .14 )mm2 、T12 (0 .61± 0 .18)mm2 较S3 (0 .61± 0 .0 7)mm2 、S4(0 .45± 0 .0 9)mm2 前根无显著差异 (P >0 .0 5 ) ,但显著小于S2 前根 (1.12± 0 .2 4)mm2 (P <0 .0 5 ) ;(2 )T11、T12 前根出硬膜平面均高于S2～ 4脊神经前根出脊髓平面 ;(3 )在脊髓圆锥平面 ,S2～ 4脊神经前后根的辨别和序列的确认较圆锥下容易。结论 :(1)利用下腹壁反射重建膀胱功能 ,宜采用T11或T12 前根与S3 或S4前根吻接并需作神经移植 ;(2 )手术宜选择在脊髓圆锥平面 ;(3 )

Objective: To provide anatomic basis for the choice of proper spinal roots , idea level of cross anastomosis and the identification of anterior spinal roots during the operation of bladder functional reconstruction with lower abdominal reflexes. Methods: T 11 , T 12 and S 2～4 anterior roots' horizontal areas, relative position and the distance between each other were observed and measured on 20 adult specimens (male 14 and female 6 ). Results: (1) There was no statistical difference between the horizontal areas of T 11 (0.70±0.14 mm 2), T 12 (0.61±0.18 mm 2) and S 3(0.61±0.07 mm 2), S 4(0.45±0.09 mm 2) anterior roots( P >0.05), but the horizontal areas of T 11 ,T 12 anterior roots was significantly less than that of S 2 anterior roots(1.12±0.24 mm 2); (2)The level of T 11 ,T 12 anterior spinal roots running through spinal dura mater was higher than that of S 2～4 anterior spinal roots originating from spinal cord; (3) To distinguish S 2～4 anterior spinal roots and to identify it's sequence was easier at L 1～L 2 centrum level than under this level. Conclusions: (1) During the operation of bladder functional reconstruction with the lower abdominal reflexes, T 11 , T 12 and S 2～4 anterior spinal roots cross anastomosis shoulder be taken and the nerve grafting are needed because of the distance between them. (2) The anastomosis should be done at spinal conus level. (3)This operation method gives a new choice for bladder functional reconstruction with somatic reflexes.