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目的:探索利用截瘫平面以上正常的体反射重建膀胱反射弧,恢复脊髓损伤后弛缓性膀胱排尿功能的可行性。方法:将Beagle犬L6前根近端与S2前根远端在硬膜内显微吻合,经一段时间的轴突再生后,建立“膝腱-脊髓中枢-膀胱”人工反射弧,术后8个月,在破坏S1～S4脊髓节段前后分别进行神经电生理、膀胱肌电图及尿流动力学和辣根过氧化物酶(HRP)逆行示踪等检查:对1例L1压缩性骨折伴截瘫患者行右侧T11与S2前根经腓肠神经移植硬膜内吻合术。结果:2只犬在术后8个月时电刺激截瘫前和截瘫后左侧L6后根、神经吻合口近端均可在吻合口远端记录到运动诱发电位,其波形和波幅相似;尿流动力学检查,当刺激开始时逼尿肌压力和膀胱内压均迅速上升,而腹内压增加幅度较小,刺激中止后膀胱内压迅速下降;膀胱注射HRP后48h实验侧L6脊髓节段前角中发现HRP标记的大神经元细胞。临床1例患者术后55个月时随访,膀胱充盈后可产生自控性排尿,尿流动力学显示排尿完全是由膀胱逼尿肌的收缩引发。结论:利用截瘫平面以上正常的体反射建立人工反射弧通路是成功和有效的,可恢复脊髓损伤后弛缓性膀胱自控性排尿。
Objective: To explore the feasibility of reconstructing the cystoid reflex arc by using normal body reflex above the plane of paraplegia to restore the flaccid urinary bladder function after spinal cord injury. Methods: The proximal end of the L6 anterior root of the Beagle dog was subdivided into the dura mater with the distal end of the S2 anterior segment. After a period of axonal regeneration, a “knee-tendon-spinal cord center-bladder” artificial reflex arc was established Eight months later, neuroelectrophysiology, bladder electromyography and urodynamics, and retrograde tracing of horseradish peroxidase (HRP) were performed before and after destroying S1 to S4 spinal cord segments. One case of L1 compressibility Fracture patients with paraplegia on the right T11 and S2 anterior root sural nerve transplantation by intradural anastomosis. Results: The electrical evoked potentials were recorded at the anastomotic distal end of the two dogs at 8 months after electrical stimulation, and the posterior roots of L6 and the proximal anastomotic nerve of paraplegia were recorded. Flow cytometry showed that detrusor pressure and intravesical pressure increased rapidly at the beginning of stimulation, but the rate of increase of intra-abdominal pressure was small, and the intravesical pressure decreased rapidly after the termination of stimulation. HRP-labeled large neurons were found in the horn. Clinical 1 patient was followed up 55 months after operation, bladder filling can produce self-control urination, urodynamics shows that urination is completely triggered by the contraction of the detrusor of the bladder. Conclusion: The establishment of artificial reflex arc pathway by normal body reflex above the plane of paraplegia is successful and effective, which can recover the flaccid bladder-controlled voiding after spinal cord injury.