利用跟腱反射重建膀胱功能的应用解剖学观察

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.

Anatomical study on bladder functional reconstruction with Achilles tendon reflex

BACKGROUND: In recent years, the method of bladder reconstruction is still at the experimental stage. Therefore, anatomical study is necessary for its clinical application.OBJECTIVE: To provide anatomical bases for the selection of proper spinal roots, the ideal level for cross anastomosis, and the identification of anterior roots of spinal nerves during bladder functional reconstruction with Achilles tendon reflexes.DESIGN: It was a single sample study with anatomical specimen as subjects.SETTING: The experiment was conducted in the department of orthopaedics of a municipal hospital.PARTICIPANTS: The experiment was completed in the Department of Anatomy, Second Military Medical University of Chinese PLA, from May 1999 to January 2000. Altogether 20 adult corpse specimens (14 males and 6females, 40 sides) were involved.INTERVENTION: The origin of spinal roots of the sacral plexus and sciatic nerve, the distribution of corresponding spinal root between the sciatic nerve and other nerves were followed up.MAIN OUTCOME MEASURES: Overlapping length, horizontal area, and relative position of anterior roots of L4-S4 spinal nerves in the dura mater.of S2 -4 anterior spinal roots originating from the spinal cord was higher than that of L4, L5 and S1 anterior spinal roots running through the dura; the cross-sectional area of L4(2. 19 ±0.39) mm2, L5(2.58 ±0.58) mm2 and S1(2.19 ± 0.42) mm2 anterior spinal roots was more than that of S2-4 anterior dentify their sequence at the terminal cone level than under this level.should be taken during bladder functional reconstruction with Achilles tendon level.