脊髓损伤后骶神经根电刺激排尿神经假体的研究进展

目的:介绍国外在脊髓损伤(SCI)患者开展骶神经根电刺激排尿的经验,并总结作者的研究结果。方法:参考Finetech-Brindley排尿神经假体工作手册,综述国外文献,详细介绍骶神经根电刺激排尿的原理、神经假体组成、临床适应证、手术方法、治疗效果、并发症、体内装置故障的判断与处理,及作者的研究工作。结果:圆锥上SCI导致的痉挛性膀胱,贮尿与排尿功能双重障碍,对患者的生活质量和生存寿命影响最大。目前骶神经根电剌激排尿在欧美国家已开展了2000多例,能恢复患者可控制性的排尿、排便和性功能,效果优良。结论:骶神经根电刺激排尿神经假体植入配合后根切断去传入,是恢复圆锥上SCI患者盆底器官排泄功能的理想方法。

A Review on the Study of Neuroprosthesis for Sacral Root Stimulated Micturition in Spinal Cord Injury Patients

Objective: To introduce the foreign experiences of sacral root stimulated micturition in spinal cord injured (SCI) patients, and summarize our research works on this subject. Methods: Based on the booklet by Finetech-Brindley for Vocare Neuroprosthesis implantation and review of literatures, the working mechanism, components, clinical indications, operative technique, results, complications, and implants failure and repair were described in detail. Results: Spastic bladders after supraconal spinal cord injuries, resulted in dual dysfunction of bladder storage and voiding, which was the leading factor for patients quality and expectancy of life. Till year 2000, more than 2000 patients have been implanted the Vocare neuroprosthesis in western countries, and the results were very good. It made the patients got bladder functions both voiding and storing, as well as rectum defecation and penile erection. Conclusion: Implantation of neuroprosthesis for sacral root stimulation combined with posterior rhizotomy for deafferentation might be an ideal method for supraconal SCI patients to restore pelvic detrusor functions.