Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma
Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma
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DOI：
10.1038/sj.sc.3101574
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发表时间：
2004-04-01
期刊：
影响因子：
2.2
通讯作者：
Gepstein, R
中科院分区：
文献类型：
--
作者：
Livshits, A;Catz, A;Gepstein, R
研究设计：慢性脊柱损伤患者的肋间神经至脊神经根吻合术。目的：分析通过人工萌芽（肋间神经至脊神经根吻合术）对脊髓损伤患者进行神经源性膀胱再神经支配的有效性。地点：俄罗斯莫斯科神经外科中心。手术由 A Livshits 教授进行。 （目前，A Livshits教授在以色列Kfar Saba梅尔总医院脊柱护理科工作。）方法：共11例L1级脊髓损伤晚期（慢性）期患者接受手术。术前及术后12个月检查神经状态和尿动力学。进行了从 T11 到 L3 的椎板切除术。接下来，在距离20-21cm处对第11和第12肋间神经进行神经松解，并将其转移到椎管内。然后将 S2 - S3 根部的近端部分切断并与肋间神经端对端吻合。尿动力学研究结果采用Wilcoxon符号秩检验计算，进行术前和术后12个月的比较。尿动力学研究结果：膀胱容量（ml）术前 - 489 +/- 79，术后 - 350 +/- 39，尿量（ml）术前 - 18.2 +/- 17，术后 - 306.4 +/- 39.8，术前残余尿（ml） - 459 +/- 99.4，之后 - 50 +/- 11.8。逼尿肌张力（相对单位）前 - 0.6 +/- 1.5，后 1.2 +/- 0.2；排尿压力 (cmH(2)O) 前 - 4.4 +/- 5.2，后 - 30.5 +/- 4.9。逼尿肌收缩力前 - 5 +/- 5.8，后 - 32.8 +/- 5.5。括约肌阻力 ( cmH2O) 之前 - 6.5 +/- 3.8，之后 - 21.1 +/- 4.2。术后第 10 至 12 个月观察到膀胱功能显着改善。恢复恢复。所有患者均发生排尿；在 11 例腹股沟和阴囊感觉异常中，有 8 例注意到球海绵体反射、肛门反射和提睾反射的再现。结论：这些结果表明，在由肋间神经提供神经供应的新条件下以及在膀胱神经与膀胱神经之间建立的新连接的情况下，膀胱中发生了恢复过程。可能受益于神经交叉手术的脊髓病变将位于圆锥处，因此功能性肋间神经可以连接到骶根以绕过损伤，试图恢复与膀胱的中央连接。
Study design: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients.Objectives: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cord-injured patients through artificial creation of sprouting ( intercostal nerve to spinal nerve root anastomosis).Setting: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. ( At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.)Methods: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late ( chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20 - 21 cm, and transferred to the vertebral canal. The S2 - S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation.Results of urodynamic studies: Bladder capacity (ml) before operation - 489 +/- 79, after operation - 350 +/- 39, urine volume (ml) before - 18.2 +/- 17, after - 306.4 +/- 39.8, residual urine (ml) before - 459 +/- 99.4, after - 50 +/- 11.8. Detrusor tone (rel. units) before - 0.6 +/- 1.5, after 1.2 +/- 0.2; voiding pressure (cmH(2)O) before - 4.4 +/- 5.2, after - 30.5 +/- 4.9. Force of detrusor contraction before - 5 +/- 5.8, after - 32.8 +/- 5.5. Sphincter resistance ( cmH2O) before - 6.5 +/- 3.8, after - 21.1 +/- 4.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of re. ex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted.Conclusion: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.