Experimental And Clinical Study On Atonic Bladder Function Reconstruction By Using Normal Lumbar And Sacral Nerve Root

Investigation of severing one nerve root of the sacral plexus in animal model:an experimental study in ratsPurpose:To observe the structure of sacral plexus in SD rats,and analysis weight of every nerve root dominating to the muscle of lower limbs.Then compare different methods of modeling, and find which one is better.Methods:1.Ten SD rats, weighing from 250g to 300g,which were provided by animal experiment center of Fu Dan university.All of rats were dissected after put to death.2. Ten SD rats,being exposed the L4,L5 and L6 nerve root to pace the stimulating electrode,then the recording electrodes were located in the triceps surae muscle, anterior tibialis muscle and biceps femoris after being exposed to record the compound muscle action potentials.3. Nine SD rats,being severed the nerve root of sacral plexus in the spinal canal,or out the spinal canal.Then study which method was better and dependable.Results:1.Three types of sacral plexus were found:(1)mainly composed of L4 and L5,with a little branch of L6.(2)Composed of L4 and L5.(3)composed of L4,L5 and L6.2. Analysis the CMAP, the triceps surae muscle was chiefly dominated by L5,then L4 and L6, anterior tibialis muscle was chiefly dominated by L4 and L5,with little dominated by L6, biceps femoris was chiefly dominated by L5,then L4 and L6.3. Severed the nerve root of sacral plexus out the spinal canal was a batter method.Conclusion:Consider the similarity between the sacral plexus of rat and of human, the model of rat was feasible to study the influence of severed one nerve root of sacral plexus, and to expose and sever the nerve root, the method of operating out the spinal canal was a batter method. The effect on lower extremity function of severing one nerve root of the sacral plexus: an experimental study in ratsPurpose:Recovery of bladder function is important in patients with conus medullaris injury. The effects of severing the S1 nerve root, to recover atonic bladder function, on motor function of the lower extremities require investigation.Methods:Forty adult male Sprague-Dawley (SD) rats were randomized into groups of 10 rats by severing the right L4, L5 and L6 nerve root, respectively, (groups B, C and D; control group A). Pre-and 4-week,8-week and 12-week postoperative electromyograms (EMGs) of the lower extremities were compared. Sciatic Functional Index (SFI), muscle weight, histological examination, and ultrastructure of the target muscle and motor end plate (MEP) were examined.Results:Relative to controls, effects were apparent in EMG at four weeks after L4 or L5, but not L6, was severed, and declined at 8 and 12 weeks. In SFI, there was a small decrease at 4 weeks, but the change was not significant or persistent. Similar results were found for muscle wet weight, except for several samples. By electron microscopy, histological examination and analysis of fiber components, we also observed significant degeneration in only a few muscle samples.Conclusion:Severance of one of the normal sacral plexus nerve roots in SD rats was feasible and did not markedly impact on lower limb motor function. Severing normal lumb and sacral anterior nerve root to reconstruct the atonic bladder function:clinical observationPurpose:At the base of animal experiment,to reconstruct function of bladder for patient with bladder dysfunction and normal function of the lower extremities by using normal lumb and sacral nerve root.Methods:In 29 patients with bladder dysfunction due to spinal cord injury and preservation of motor function of the lower extremities, the central end of normal lumb and sacral nerve root on the unaffected spinal segment was anastomosed with the peripheral end of S2 (or S3) anterior nerve root that dominates the bladder to establish a new artificial bladder reflex arc in an attempt to recover the bladder function. Differences in motor function and electromyogram of the involved parts of the lower extremities were observed. After the operation the bladder funtion was followed up,which include rinary output, residual urine, urinary tract infection and life quality.Results:Six patients who had normal lumb and sacral nerve root severed subjectively reported a sensation of slightly decreased strength of the lower leg after operation. Postoperative physical examination showed that ankle plantar flexor muscle strength(MRC scale) decreased by 0.5 degree. Electromyogram of lower limb showed that sixteen amplitudes of common peroneal nerve, six amplitudes of tibial nerve, three mplitudes of common peroneal nerve and tibial nerve were decreased. Twenty patients had improvements of bladder functions with more volume of micturition and less residual urine. Other nine patients had no obviously improvement.Conclusion:Severing normal lumb and sacral anterior root can reconstruct the atonic bladder function safely and efficiently. Primary study of the mechanism of compensation between lumbar or sacral roots:an experiment in macaques to study the nerve domination rule of muscles in lower limbsPurpose:To observe the structure of sacral plexus in macaque, and analysis weight of every nerve root dominating to the muscle of lower limbs.Then investigate mechanism of compensation between the nerve roots.Methods:the macaques were dissected to observe the structure of sacral plexus, and then four macaques were exposed the L3,L4,L5,L6,L7 and S1 nerve root to pace the stimulating electrode, then the recording electrodes were located in the quadriceps femoris muscle, biceps femoris, triceps surae muscle, anterior tibialis muscle and long extensor muscle of toes to record the compound muscle action potentialsResults:Analysis weight of every nerve root dominating to the muscle of lower limbs by CMAP. We found that each muscle was dominated by a intensive nerve root. The quadriceps femoris muscle was dominated mainly by L4. The biceps femoris was dominated mainly by L6. The triceps surae muscle was dominated mainly by L7. The anterior tibialis muscle was dominated mainly by L5. The long extensor muscle of toes was dominated mainly by L6. However the nerve roots neighboring also participate in the domination.Conclusion:lumbar plexus of macaques were composed by L3-L5,and the sacral poexus were composed by L5-L7. Each muscle was dominated by a intensive nerve root. But the nerve roots neighboring also participate in the domination, the number of which were two and more.