Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a possible technique to restore lower urinary tract innervation.
Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a possible technique to restore lower urinary tract innervation.
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DOI：
10.3171/2012.7.spine12214
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Ruggieri MR Sr
中科院分区：
文献类型：
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作者：
Brown JM;Barbe MF;Albo ME;Lai HH;Ruggieri MR Sr
神经移位可以有效地恢复瘫痪的躯体肌群的控制，最近甚至可以在犬的模型中恢复失去神经支配的逼尿肌。在身体上进行了一项试点项目，以研究将躯体神经转移到盆腔神经的膀胱支作为潜在恢复神经以控制人类逼尿肌的方法的可行性。对11具身体进行双侧解剖，显露肋间神经、髂腹股沟神经和髂腹下神经，以及盆神经的膀胱支。评估前3条神经移位至盆腔膀胱神经的便捷性和能力，以及神经横截面积。盆腔膀胱神经位于膀胱底，位于输尿管下方，伴行膀胱下血管。T-11和T-12肋间神经太短，不能直接移植到盆腔膀胱神经。髂腹股沟神经和髂腹下神经(L-1起源)在腹膜后被识别，并在完全解剖的情况下，很容易在腹内转移到盆腔膀胱神经。盆腔膀胱优势支横截面积为2.60±0.169 mm~2，髂腹股沟和髂腹下支横截面积为2.38±0.32 mm~2。根据解剖位置和横截面积，使用髂腹股沟或髂腹下神经异位移位到盆腔膀胱神经在手术上是可行的。
Nerve transfers are effective for restoring control to paralyzed somatic muscle groups and, recently, even to denervated detrusor muscle in a canine model. A pilot project was performed in cadavers to examine the feasibility of transferring somatic nerves to vesical branches of the pelvic nerve as a method for potentially restoring innervation to control the detrusor muscle in humans. Eleven cadavers were dissected bilaterally to expose intercostal, ilioinguinal, and iliohypogastric nerves, along with vesical branches of the pelvic nerve. Ease of access and ability to transfer the former 3 nerves to the pelvic vesical nerves were assessed, as were nerve cross-sectional areas. The pelvic vesical nerves were accessed at the base of the bladder, inferior to the ureter and accompanied by inferior vesical vessels. The T-11 and T-12 intercostal nerves were too short for transfer to the pelvic vesical nerves without grafting. Ilioinguinal and iliohypogastric nerves (L-1 origin) were identified retroperitoneally and, with full dissection, were easily transferred to the pelvic vesical nerves intraabdominally. The mean cross-sectional area of the dominant pelvic vesical branch was 2.60 ± 0.169 mm2; ilioinguinal and iliohypogastric branches at the suggested transection site were 2.38 ± 0.32 mm2 (the means are expressed ± SEM). Use of the ilioinguinal or iliohypogastric nerves for heterotopic transfer to pelvic vesical nerves is surgically feasible, based on anatomical location and cross-sectional areas.