Innervation of the detrusor muscle bundle in neurogenic detrusor overactivity
Innervation of the detrusor muscle bundle in neurogenic detrusor overactivity
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DOI：
10.1046/j.1464-410x.2003.04186.x
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发表时间：
2003-05-01
影响因子：
4.5
通讯作者：
Brading, AF
中科院分区：
文献类型：
--
作者：
Drake, MJ;Gardner, BP;Brading, AF
目的探讨逼尿肌肌束内神经支配的外周解剖分布及神经源性逼尿肌过度活动（DO）的变化。患者与方法对3例尸体移植器官供体和4例脊髓损伤致神经源性DO患者膀胱穹窿全层标本进行比较。采用马松三色法、弹性蛋白法和波形蛋白免疫组化技术对系统连续低温冷冻切片进行染色。生成相干图像堆栈用于三维图像重建，使用混合渲染（即不同组织成分的不同图形）显示针对肌束框架的束周和束内神经支配。结果对照标本神经供应较密。肌束神经支配来源于束间结缔组织的束周神经干的二分分支。横向束间枝在束的中点垂直于长轴进入束。它们产生轴向束间分支，分布于前末梢神经纤维和末梢神经纤维。所有来自神经源性DO患者的样本均有斑片状去神经支配。原发性缺损主要发生在末梢轴向神经支配水平，并沿肌束纵轴横断面一致。结论斑状失神经支配可能反映了周围神经节水平的缺陷。去神经支配区域的任何收缩，要么与膀胱的其余部分不协调，要么通过非神经结构进行协调。细肌束在肌束之间的运动和结缔组织锚定结构的观察，代表了两种可能影响这种协调的假设机制。
OBJECTIVETo evaluate the peripheral anatomical distribution of innervation within muscle bundles of the detrusor and the changes arising in neurogenic detrusor overactivity (DO).PATIENTS AND METHODSFull-thickness samples from the bladder dome of three cadaveric transplant organ donors and four people with neurogenic DO caused by spinal cord injury were compared. Systematic serial cryostat sections were stained using Masson trichrome and elastin techniques, and vimentin immunohistochemistry. A coherent image stack was generated for three-dimensional image reconstructions, which were displayed using mixed rendering (i.e. differing graphics for separate tissue components) to show peri- and intra-bundle innervation against the muscle fascicle framework.RESULTSControl specimens had a dense nerve supply. Muscle bundle innervation was derived by dichotomous branching from peri-bundle nerve trunks in the inter-bundle connective tissue. Transverse interfascicular branches entered bundles perpendicular to the long axis at the midpoint of the bundle. They gave rise to axial interfascicular branches, which distributed to the pre-terminal and terminal nerve fibres. All samples from patients with neurogenic DO had patchy denervation. The primary deficit was predominantly at the level of the terminal axial innervation and was cross-sectionally consistent along the longitudinal axis of the muscle bundle.CONCLUSIONPatchy denervation may reflect a deficit at the level of the peripheral ganglia. Any contraction in the areas of denervation either occurs out of co-ordination with the rest of the bladder, or is co-ordinated by means of non-neural structures. The observation of fine muscle strands running between fascicles, and connective tissue anchoring structures, represent two hypothetical mechanisms by which such co-ordination might be effected.