Reinnervation of urethral and anal sphincters with femoral motor nerve to pudendal nerve transfer.
Reinnervation of urethral and anal sphincters with femoral motor nerve to pudendal nerve transfer.
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DOI：
10.1002/nau.21171
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发表时间：
2011-11
影响因子：
2
通讯作者：
Barbe, Mary F.
中科院分区：
文献类型：
--
作者：
Ruggieri, Michael R., Sr.;Braverman, Alan S.;Bernal, Raymond M.;Lamarre, Neil S.;Brown, Justin M.;Barbe, Mary F.
关键词：
骶神经根或神经的下运动神经元损伤可导致尿失禁和膀胱松弛。我们发现膀胱神经再支配后，尾骨转移到骶神经前根，生殖股神经（L1，2起源）骨盆神经。本研究评估了在犬模型中，将股神经（L2-4起源）的运动分支转移到支配尿道和肛门括约肌的阴部神经（S1，2起源），从而进行尿道和肛门括约肌神经再支配的可行性。根据骶前根刺激膀胱、尿道括约肌和肛门括约肌收缩的能力选择骶前根并切断。双侧，股神经的分支，特别是隐神经肌部[Evans HE。米勒对狗的解剖。费城：W.B.桑德斯; 1993]，转移并端对端闭合至会阴中横切的阴部神经分支，然后封闭在单极神经袖带电极中，电极导线连接至植入的RF微刺激器。神经刺激诱导增加肛门和尿道括约肌的压力，在六个转移的神经。使用荧光金、固蓝和荧光红对膀胱、尿道括约肌和肛门括约肌进行逆行神经追踪，证实神经移植犬的L2-4脊髓段（而非S1-3）中尿道和肛门括约肌标记的神经元，与转移的股神经运动分支的神经再支配一致。对照组仅在S1-3节段标记神经元。死后DiI和DiO标记证实轴突再生穿过神经修复部位。这些结果显示骶神经前根切断和股神经转移（NT）到去神经支配的阴部神经后，尿道和肛门括约肌的脊髓神经再支配。这些外科手术可以使患者恢复视力。
Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence.
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影响因子：
1.9
作者：
GAUL, JS
通讯作者：
GAUL, JS
影响因子：
4.2
作者：
Ruggieri, Michael R., Sr.;Braverman, Alan S.;Barbe, Mary F.
通讯作者：
Barbe, Mary F.
影响因子：
7.4
作者：
Christianson, Julie A.;Liang, Ruomei;Pezzone, Michael A.
通讯作者：
Pezzone, Michael A.
影响因子：
6.6
作者：
Ali-El-Dein, B;Ghoneim, MA
通讯作者：
Ghoneim, MA
影响因子：
6.6
作者：
HACKLER, RH
通讯作者：
HACKLER, RH