Extradural Nerve Anastomosis Technique for Bladder Reinnervation in Spinal Cord Injury Anatomical Feasibility Study in Human Cadavers
Extradural Nerve Anastomosis Technique for Bladder Reinnervation in Spinal Cord Injury Anatomical Feasibility Study in Human Cadavers
复制标题
脊髓损伤膀胱神经重建的硬膜外神经吻合技术在人体尸体中的解剖可行性研究
DOI：
10.1097/brs.0000000000000208
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发表时间：
2014
期刊：
影响因子：
3
通讯作者：
Cao Xiaojian
中科院分区：
文献类型：
--
作者：
Zhou Xiaoji;Liu Yongtao;Ma Jun;Sui Tao;Ge Yingbin;Cao Xiaojian
研究设计。9具防腐尸体的硬膜外脊根解剖研究。目的。确定硬膜外脊根的解剖参数，并证明在不打开硬脑膜的情况下进行脊根吻合的可行性。背景数据摘要。脊根硬膜内吻合在治疗脊髓损伤神经源性膀胱方面取得了突破性进展。然而，由于手术操作复杂，骨破坏广泛，其临床应用并没有得到广泛推广。在手术显微镜下测量神经根出口至神经节中心的距离、相邻神经根出口的距离以及硬膜外脊神经根的大体解剖。结果：硬膜外脊神经根的最长和最短长度分别在S4和T7水平，平均值分别为33.29和6.06 mm。相邻神经根出口之间的距离在L1-L2最长（平均29.16 mm），在S3-S4最短（平均11.79 mm）。脊神经根离开硬脊膜囊后，在椎管内下行，直至到达相应的椎间孔，运动神经根仍位于感觉神经根的腹侧。结论：在硬脊膜囊外可以成功地分离和识别脊神经后根和VRs。S1 VR可在硬膜外与S2 VR吻合，无需神经移植。对于胸VR到S2 VR的硬膜外神经吻合，需要神经移植物。此外，在T7-T12和S1水平有足够数量的神经纤维用于功能性膀胱恢复。本研究支持硬膜外脊神经根吻合术作为治疗神经源性膀胱的改良手术方法的可行性。证据等级：N/A硬膜内神经吻合术用于膀胱神经再支配的手术过程复杂，并且在打开硬膜囊时总是与术后并发症相关，例如脑脊液漏。在这里，我们提出了一种改良的手术方法，显示出相当大的临床前景的SCI患者不打开硬脊膜囊。
Study Design.An anatomic study of extradural spinal root in 9 embalmed cadavers.Objective.To ascertain the anatomical parameters of the extradural spinal root and to demonstrate the feasibility of spinal root anastomoses without opening the spinal dura mater.Summary of Background Data.Intradural anastomosis of the spinal root has made breakthrough progress in treating neurogenic bladder in spinal cord injury. However, because of the complex surgical procedures and extensive bony destruction, its clinical use is not widely promoted.Methods.Nine formalin-fixed cadavers were used. The distance between the nerve root outlet and ganglion center, the neighboring nerve root-outlet distance, and the gross anatomy of the extradural spinal root were measured with a surgical microscope. The number of nerve fibers from the T7 to S4 ventral roots (VRs) was calculated by immunohistochemical staining.Results.The longest and shortest lengths of the extradural spinal root were observed at the S4 and T7 levels, with average values of 33.29 and 6.06 mm, respectively. The longest distance between the adjacent nerve root outlets was observed at L1–L2 (mean, 29.16 mm), and shortest at S3–S4 (mean, 11.79 mm). After leaving the dural sac, the spinal root descends in the spinal canal until reaching the corresponding intervertebral foramina, and the motor nerve roots still lie ventrally to the sensory nerve roots. The largest and smallest numbers of nerve fibers were observed at the L3 and S4 levels (mean, 9169 and 1356, respectively).Conclusion.The dorsal roots and VRs can both be successfully harvested and identified outside the dural sac. The S1 VR can be anastomosed to the S2 VR extradurally without nerve grafts. For extradural neuroanastomosis of the thoracic VRs to the S2 VR, a nerve graft is required. In addition, there are a sufficient number of nerve fibers for functional bladder recovery at the T7–T12 and S1 levels. This study supports the feasibility of extradural spinal root anastomosis as a modified surgical method for treating neurogenic bladder.Level of Evidence: N/AThe surgical procedure of intradural nerve anastomosis for bladder reinnervation is complex and always associated with postoperative complications, such as cerebrospinal fluid leakage, when opening the dural sac. Here, we proposed a modified surgical procedure that shows considerable clinical promise for patients with SCI without opening the dural sac.