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背景:近年来出现的一些膀胱重建方法尚处于实验研究阶段,离临床应用还有差距。目的:为跟腱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。设计:以解剖学标本为研究对象的单一样本观察。单位:一所市级医院的骨科。对象:实验于1999-05/2000-01在第二军医大学解剖学教研室完成。20具尸体标本,男14例,女6例,40侧。干预:在20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他神经之间的分布。主要观察指标: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(46%)的贡献最大。②S2～4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±0.39),L5(2.58±0.58)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。
Background: Some bladder reconstruction methods that have emerged in recent years are still in the experimental stage, and there is still a gap from clinical application. OBJECTIVE: To provide anatomic evidence for the selection of the anterior spinal cord root and the kiss plane in the operation of Achilles tendon reflex reconstruction of the bladder function and the localization of the anterior root of the spinal nerve. Design: A single sample of anatomical specimens for the study. Unit: a city hospital orthopedic. PARTICIPANTS: The experiment was performed in Department of Anatomy, Second Military Medical University from May 1999 to January 2000. 20 specimens of dead bodies, 14 males and 6 females, 40 sides. INTERVENTIONS: Tracing the source of the dorsal roots of the sacral plexus and sciatic nerve on 20 cadaver specimens, the distribution of the corresponding dorsal root nerve between the sciatic nerve and other nerves. MAIN OUTCOME MEASURES: The positional relationship of anterior dorsal root of L4 ~ S4 spinal cord in dura mater, overlapping length and cross-sectional area. Results: (1) The sacral plexus mainly consisted of L4, L5 and S1-5 spinal nerve roots, of which L5 spinal nerve roots (46%) contributed the most. (2) The level of spinal cord in S2 ~ 4 was higher than that in L4, L5 and S1, and the cross sectional area of L4 (2.19 ± 0.39), L5 (2.58 ± 0.58) and S1 (2.19 ± 0.42 ) mm2 were significantly greater than S2 ~ 4 before the root. ③ in the conical plane of the spinal cord, the identification of the anterior and posterior roots and the confirmation sequence easier than the cone. Conclusion: ① The use of Achilles tendon reflex reconstruction of bladder function should use L5 anterior root and S3 or S4 before the root cross-kiss. ② kiss the plane should choose the conus in the spinal cord.