利用跟腱反射重建膀胱功能的应用解剖学研究

Operation of bladder functional reconstruction with Achilles tendon reflex: applied anatomic study

目的 :为进行跟腱反射重建膀胱功能的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具尸体标本上追踪骶丛和坐骨神经的脊神经根来源、相应的脊神经根在坐骨神经和其它神经之间的分布 ,同时观察硬膜内L4～S4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 :(1)骶丛主要由L4、L5和S1～ 5脊神经根组成 ,其中L5脊神经根 (4 6% )的贡献最大 ;(2 )S2～ 4前根出脊髓的平面均高于L4、L5和S1前根出硬膜的平面 ,前根的横截面积L4(2 .19± 0 .3 9)mm2 、L5(2 .5 8± 0 .5 8)mm2 和S1(2 .19± 0 .42 )mm2 均显著大于S2～ 4前根 ;(3 )在脊髓圆锥平面 ,前后根的辨别和序列的确认较圆锥下容易。结论 :(1)利用跟腱反射重建膀胱功能时宜选用L5前根与S3 或S4前根交叉吻接 ;(2 )吻接平面宜选择在脊髓圆锥处。

Objective: To provide anatomic basis for the choice of proper spinal roots, the ideal level for cross anastomosis and the identification of anterior spinal roots during the operation of bladder functional reconstruction with Achilles tendon reflex. Methods: The spinal roots' origin of sacral plexus as well as L 4～S 1 and S 2～S 4 anterior roots' overlapping length, horizontal area and relative position between each other were observed and measured in 20 abult specimens (male 14 and female 6). Results: (1) Sacral plexus were mainly composed of L 4, L 5 and S 1 spinal root's contribution were the most dominant; (2) The level of S 2～4 anterior spinal roots originating from spinal cord was higher than that of L 4, L 5 and S 1 anterior spinal roots running through meninx and the horizontal area of L 4, L 5 and S 1 anterior spinal roots was more than that of S 2～4 anterior spinal roots; (3) To distinguish the anterior spinal roots and to identify it's sequence was easier at the terminal cone level than under this level. Conclusions: (1) S 1～S 3 or S 1～S 4 anterior spinal roots cross anastomosis should be taken during the operation of bladder functional reconstruction with Achilles tendon reflex; (2) The anastomosis should be done at the terminal cone level.