PDF(Pubmed)
Abstract：
Bladder dysfunction after nerve injury has a variable presentation, and extent of injury determines whether the bladder is spastic or atonic. The authors have proposed a series of 3 nerve transfers for functional innervation of the detrusor muscle and external urethral sphincter, along with sensory innervation to the genital dermatome. These transfers are applicable to only cases with low spinal segment injuries (sacral nerve root function is lost) and largely preserved lumbar function. Transfer of the posterior branch of the obturator nerve to the vesical branch of the pelvic nerve provides a feasible mechanism for patients to initiate detrusor contraction by thigh adduction. External urethra innervation (motor and sensory) may be accomplished by transfer of the vastus medialis nerve to the pudendal nerve. The sensory component of the pudendal nerve to the genitalia may be further enhanced by transfer of the saphenous nerve (sensory) to the pudendal nerve. The main limitations of coapting the nerve donors to their intrapelvic targets are the bifurcation or arborization points of the parent nerve. To ensure that the donor nerves had sufficient length and diameter, the authors sought to measure these parameters.
Twenty-six pelvic and anterior thigh regions were dissected in 13 female cadavers. After the graft and donor sites were clearly exposed and the branches identified, the donor nerves were cut at suitable distal sites and then moved into the pelvis for tensionless anastomosis. Diameters were measured with calipers.
The obturator nerve was bifurcated a mean ± SD (range) of 5.5 ± 1.7 (2.0-9.0) cm proximal to the entrance of the obturator foramen. In every cadaver, the authors were able to bring the posterior division of the obturator nerve to the vesical branch of the pelvic nerve (located internal to the ischial spine) in a tensionless manner with an excess obturator nerve length of 2.0 ± 1.2 (0.0-5.0) cm. The distance between the femoral nerve arborization and the anterior superior iliac spine was 9.3 ± 1.8 (6.5-15.0) cm, and the distance from the femoral arborization to the ischial spine was 12.9 ± 1.4 (10.0-16.0) cm. Diameters were similar between donor and recipient nerves.
The chosen donor nerves were long enough and of sufficient caliber for the proposed nerve transfers and tensionless anastomosis.
Twenty-six pelvic and anterior thigh regions were dissected in 13 female cadavers. After the graft and donor sites were clearly exposed and the branches identified, the donor nerves were cut at suitable distal sites and then moved into the pelvis for tensionless anastomosis. Diameters were measured with calipers.
The obturator nerve was bifurcated a mean ± SD (range) of 5.5 ± 1.7 (2.0-9.0) cm proximal to the entrance of the obturator foramen. In every cadaver, the authors were able to bring the posterior division of the obturator nerve to the vesical branch of the pelvic nerve (located internal to the ischial spine) in a tensionless manner with an excess obturator nerve length of 2.0 ± 1.2 (0.0-5.0) cm. The distance between the femoral nerve arborization and the anterior superior iliac spine was 9.3 ± 1.8 (6.5-15.0) cm, and the distance from the femoral arborization to the ischial spine was 12.9 ± 1.4 (10.0-16.0) cm. Diameters were similar between donor and recipient nerves.
The chosen donor nerves were long enough and of sufficient caliber for the proposed nerve transfers and tensionless anastomosis.
摘要：
目的：神经损伤后膀胱功能障碍有不同的表现，和损伤的程度决定了膀胱是痉挛还是失稳。作者提出了一系列3个神经转移，用于逼尿肌和尿道外括约肌的功能性神经支配，以及生殖器皮肤的感觉神经支配。这些转移仅适用于低脊柱节段损伤（骶神经根功能丧失）和大部分保留的腰椎功能的病例。将闭孔神经的后支转移到骨盆神经的膀胱支，为患者通过大腿内收启动逼尿肌收缩提供了可行的机制。尿道外神经支配（运动和感觉）可以通过将股内侧神经转移到阴部神经来实现。阴部神经到生殖器的感觉成分可以通过将隐神经(感觉)转移到阴部神经而进一步增强。将神经供体接合到其肾盂内靶标的主要限制是母神经的分叉或分叉点。为了确保供体神经有足够的长度和直径，作者试图测量这些参数。
方法：解剖了13具女性尸体的26个骨盆和大腿前区。在移植物和供体部位清晰暴露并确定分支后，在远端适当部位切断供体神经,然后移入骨盆进行无张力吻合.用卡尺测量直径。
结果：闭孔神经在闭孔入口近端分叉，平均值±SD（范围）为5.5±1.7（2.0-9.0）cm。在每一具尸体中，作者能够以无张力的方式将闭孔神经的后段带到骨盆神经的膀胱分支（位于坐骨脊柱内部），并且闭孔神经的多余长度为2.0±1.2（0.0-5.0）cm。股神经离骨距髂前上棘距离为9.3±1.8(6.5～15.0)cm,从股骨干到坐骨脊柱的距离为12.9±1.4（10.0-16.0）cm。供体和受体神经的直径相似。
结论：所选择的供体神经足够长，并且具有足够的口径，可以进行拟议的神经转移和无张力吻合。
方法：解剖了13具女性尸体的26个骨盆和大腿前区。在移植物和供体部位清晰暴露并确定分支后，在远端适当部位切断供体神经,然后移入骨盆进行无张力吻合.用卡尺测量直径。
结果：闭孔神经在闭孔入口近端分叉，平均值±SD（范围）为5.5±1.7（2.0-9.0）cm。在每一具尸体中，作者能够以无张力的方式将闭孔神经的后段带到骨盆神经的膀胱分支（位于坐骨脊柱内部），并且闭孔神经的多余长度为2.0±1.2（0.0-5.0）cm。股神经离骨距髂前上棘距离为9.3±1.8(6.5～15.0)cm,从股骨干到坐骨脊柱的距离为12.9±1.4（10.0-16.0）cm。供体和受体神经的直径相似。
结论：所选择的供体神经足够长，并且具有足够的口径，可以进行拟议的神经转移和无张力吻合。
