选择性骶神经前后根组合切断恢复脊髓损伤后膀胱功能的实验研究

目的：探讨脊髓损伤后膀胱完全性去神经传入手术的替代方法。方法：健康杂种犬16只经T10平面截瘫后，按L7－S3神经根切断程度的不同，从完全保留到完全切断分成六组，比较术中神经根（总根和后根）电刺激时的膀胱尿道压力变化和术后膀胱压力容积曲线（CMG）变化。结果 （1）电刺激研究：犬磅胱的神经支配以S2为主，S1次之，尿道的神经支配以S1为主，S2次之，在保留S1或S2前后根完整的情况下，刺激同平面S1或S2的总根或后根，膀胱尿道的压力反应相同，切断S1或S2前根，刺激同平面的S1或S2后根，膀胱尿道的压力反应显著降低。（2）CMG研究：保留同一平面S1或S2前后根的完整，其CMG曲线与完全不切断的对照组相似，形成痉挛性膀胱，不保留同一平面前后根的完整，即切断S1或S2前根，其CMG曲线与切断全部后根的对照组相似，形成驰缓性膀胱，结论 不同平面的骶神经前后根组合切断，能获得与完全性后根切断相同的膀胱去神经效果。

EXPERIMENTAL STUDY ONCOMBINING SELECTIVE RHIZOTOMY OF DIFFERENT ANTERIOR AND POSTERIOR SACRAL ROOTS FORRESTORATION OF BLADDER FUNCTION AFTER SPINAL CORD INJURY

OBJECTIVE: To investigate an alternative procedure for complete denervation of bladder in the supra-cone cord injury to restore the bladder function. METHODS: Sixteen dogs were included in this study after their spinal cords were transected above the cone. They were divided into 6 groups and performed the rhizotomy of L7 to S3 root in different combination respectively. The bladder and urethra pressure change by electrostimulation during operation and cystometrogram change after operation were tested. RESULTS: 1. Electrostimulation study: for bladder innervation, S2 was the most important and S1 was secondary. While for urethra innervation, S1 was more important than S2. When the anterior and posterior roots of S1 and S2 were intact with rhizotomy of posterior roots of L7 and S3, stimulated the common or posterior root of S1 and S2, the change of pressure in bladder and urethra was the same. When the anterior roots of S1 and S2 were resected with rhizotomy of posterior roots of L7 and S3, the pressure in bladder and urethra was significant decreased compared to stimulating the corresponding posterior roots. 2. Cystometrogram (CMG) study: in the complete deafferented group, resecting the posterior roots of L7 to S3, the bladder became flaccid. While resecting the posterior root of S2 and anterior root of S1 or, resecting the posterior root of S1 and anterior root of S2, combining with rhizotomy of posterior roots of L7 and S3, the CMG curve was similar to the complete deafferented group. In the S1 and S2 intact group, the bladder became spastic. CONCLUSION: Combining rhizotomy of anterior and posterior sacral root in different level has the same effects on bladder as complete deafferentation.