Restoring bladder function using motor and sensory nerve transfers: a cadaveric feasibility study.
Restoring bladder function using motor and sensory nerve transfers: a cadaveric feasibility study.
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使用运动和感觉神经转移恢复膀胱功能：一项尸体可行性研究。
DOI：
10.3171/2022.8.spine22291
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发表时间：
2023-02-01
影响因子：
2.8
通讯作者：
Brown, Justin M.
中科院分区：
文献类型：
--
作者：
Johnston, Benjamin R.;Bazarek, Stanley;Sten, Margaret;McIntyre, Brian S.;Fine, Noam;De, Elise J. B.;McGovern, Francis;Lemos, Nucelio;Ruggieri, Michael R.;Barbe, Mary F.;Brown, Justin M.
神经损伤后的膀胱功能障碍是一种可变的表现，其中损伤的程度决定了膀胱是痉挛还是弛缓。我们提出了一系列的3神经转移的逼尿肌和尿道外括约肌功能的功能性运动恢复，沿着感觉神经再支配生殖器皮节。这些转移仅适用于骶神经根功能丧失但腰椎功能基本保留的下脊柱节段损伤。首次将闭孔神经后分支转移至盆神经膀胱前分支为患者通过大腿内收启动逼尿肌收缩提供了可行的机制。第二，外尿道神经支配（运动和感觉）可以通过将主要的运动股内侧肌神经转移到阴部神经来实现。最后，阴部神经到生殖器的感觉成分可以通过将隐神经（感觉）转移到阴部神经来进一步增强。将大腿前室中的神经连接到其骨盆目标的主要限制是其母神经的分叉或分支点。为了确保供体神经有足够的长度和直径，我们试图测量这些参数。在13具女性尸体上解剖了26个骨盆和大腿前部区域。在明确暴露移植物和供区并确定分支后，在合适的远端部位切断供神经，然后移入骨盆进行无张力吻合。使用卡尺测量直径。闭孔神经在距闭孔口5.5cm处分叉（SD 1.7cm，范围2.0- 9.0cm）。在每具尸体中，我们能够以无张力的方式将闭孔神经的后分支带到骨盆神经的前膀胱分支（位于坐骨棘内部），闭孔神经的长度超过2.0 cm（SD 1.2 cm，范围0.0-5.0 cm）。股神经分支与髂前上级棘之间的距离为9.3 cm（SD 1.8 cm，范围6.5-15.0 cm），股神经分支与坐骨棘之间的距离为12.9 cm（SD 1.4 cm，范围10.0-16.0 cm）。供、受神经直径相似。所选择的供体神经足够长，并且具有足够的口径用于所提议的神经转移和无张力吻合。
Bladder dysfunction after nerve injury is a variable presentation where the extent of injury determines if the bladder is spastic or atonic. We propose a series of 3 nerve transfers for functional motor restoration of detrusor and external urethral sphincter function, along with sensory reinnervation to the genital dermatome. These transfers would be applicable only in the case of low spinal segment injuries in which sacral nerve root function is lost, but lumbar function is largely preserved. The first transfer of the posterior branch of the obturator nerve to the anterior vesical branch of the pelvic nerve provides a feasible mechanism for patients to initiate detrusor contraction by thigh adduction. Second, external urethra innervation (motor and sensory) may be accomplished by transfer of the primarily motor vastus medialis nerve to the pudendal nerve. Finally, the sensory component of the pudendal nerve to the genitalia may be further enhanced by transfer of the saphenous nerve (sensory) to the pudendal nerve. The main limitations for connecting the nerves in the anterior compartment of the thigh to their pelvic targets are the bifurcation or arborization points of their parent nerve. To ensure the donor nerves had enough length and diameter, we sought to measure these parameters. Twenty-six pelvic and anterior thigh regions were dissected in 13 female cadavers. After the graft and donor sites were clearly exposed and branches identified, the donor nerves were cut at suitable distal sites and then moved into the pelvis for a tensionless anastomosis. Diameters were measured using calipers. The obturator nerve bifurcated 5.5 cm from the entrance of the obturator foramen (SD 1.7 cm, range 2.0-9.0 cm). In every cadaver, we were able to bring the posterior division of the obturator nerve to the anterior vesical branch of the pelvic nerve (located internal to the ischial spine) in a tensionless manner with an excess obturator nerve length of 2.0 cm (SD 1.2 cm, range 0.0-5.0 cm). The distance between the femoral nerve arborization and the anterior superior iliac spine was 9.3 cm (SD 1.8 cm, range 6.5-15.0 cm) and the femoral arborization to the ischial spine was 12.9 cm (SD 1.4 cm, range 10.0-16.0 cm). Diameters were similar between donor and recipient nerves. The chosen donor nerves were long enough and of sufficient caliber for the proposed nerve transfers and a tensionless anastomosis.
DOI：
10.4103/0970-1591.65399
发表时间：
2010-04
期刊：
Indian journal of urology : IJU : journal of the Urological Society of India
影响因子：
--
作者：
Harrison SC
通讯作者：
Harrison SC
影响因子：
2
作者：
Ruggieri, Michael R., Sr.;Braverman, Alan S.;Bernal, Raymond M.;Lamarre, Neil S.;Brown, Justin M.;Barbe, Mary F.
通讯作者：
Barbe, Mary F.