脊髓圓錐損傷膀胱功能重建術后大鼠逼尿肌顯微結構變化研究_《中國修復重建外科雜志》

作者：

張月雷 , 盛珺 , 侯春林 , 林浩東

上海長征醫院骨科（上海，200003）;

關鍵詞：

脊髓圓錐損傷膀胱功能重建逼尿肌神經肌肉接頭大鼠

DOI：

10.7507/1002-1892.20130183

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目的通過觀察脊髓圓錐損傷膀胱功能重建術后大鼠膀胱逼尿肌及神經肌肉接頭（neuromuscular junction，NMJ）的形態學變化規律，探討膀胱重建術抑制或改善膀胱逼尿肌退行性變的可行性。方法成年雌性SD大鼠104只，體重200～250 g，隨機分為3組，正常組（n=8）、脊髓圓錐損傷對照組（對照組，n=48）及脊髓圓錐損傷膀胱功能重建組（實驗組，n=48）。正常組大鼠不作任何處理；對照組大鼠采用L4、5平面銳性橫斷脊髓制作脊髓圓錐損傷模型；實驗組在脊髓圓錐損傷模型基礎上將雙側L5前、后根與S2前、后根吻合制作脊髓圓錐損傷后膀胱功能重建模型。術后觀察大鼠存活情況，于術后3 d及1、2、3、4、5、6個月前連續3 d分別測定大鼠殘余尿量；術后1、2、3、4、5、6個月取膀胱逼尿肌行HE染色觀測肌纖維截面積變化規律，Masson三色染色計算結締組織百分比，透射電鏡觀察膀胱逼尿肌和NMJ的變化。結果術后11只大鼠死亡，均對應補充。對照組術后膀胱殘余尿量隨時間延長逐漸增加（P lt; 0.05）；實驗組術后膀胱殘余尿量逐漸增加，3個月后逐漸減少，除術后3 d與5個月比較差異無統計學意義（P gt; 0.05）外，其余各時間點間比較差異均有統計學意義（P lt; 0.05）。兩組間除術后3 d及1、2個月外，其余各時間點比較，差異均有統計學意義（P lt; 0.05）。HE染色及Masson三色染色示，對照組術后逼尿肌肌纖維排列紊亂、萎縮隨時間延長逐漸加重，肌束間大量結締組織浸潤；實驗組術后4、5、6個月逼尿肌形態逐漸恢復，結締組織數量無明顯增加。各時間點對照組及實驗組逼尿肌肌纖維截面積及結締組織百分比與正常組比較，差異均有統計學意義（P lt; 0.05）。對照組隨時間延長逼尿肌肌纖維截面積逐漸減小，結締組織百分比逐漸增加（P lt; 0.05）。實驗組中術后3個月內隨時間延長逼尿肌肌纖維截面積下降，4個月后逐漸增大；結締組織百分比隨時間延長緩慢增加。術后1、2、3個月實驗組與對照組比較逼尿肌肌纖維截面積無統計學意義（P gt; 0.05），4、5、6個月實驗組顯著高于對照組（P lt; 0.05）；術后1～6個月實驗組與對照組結締組織百分比比較，均有統計學意義（P lt; 0.05）。透射電鏡觀察示，對照組隨時間延長，突觸小泡數量明顯減少，3個月時NMJ呈空泡狀改變，6 個月時罕見逼尿肌間NMJ；實驗組中1、3個月逼尿肌細胞間的NMJ內突觸小泡數量減少，6個月時突觸小泡較3個月時明顯增多。結論利用損傷平面以上正常的L5神經根作為動力神經重建脊髓圓錐損傷后大鼠膀胱功能，能夠有效延緩膀胱逼尿肌退行性變，改善其顯微結構變化。

引用本文： 張月雷,盛珺,侯春林,林浩東. 脊髓圓錐損傷膀胱功能重建術后大鼠逼尿肌顯微結構變化研究. 中國修復重建外科雜志, 2013, 27(7): 836-842. doi: 10.7507/1002-1892.20130183 復制

1.	Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumber and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
2.	Benevento BT, Sipski ML. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther, 2002, 82(6): 601-612.
3.	Jeong SJ, Cho SY, Oh SJ. Spinal cord/brain injury and the neurogenic bladder. Urol Clin North Am, 2010, 37(4): 537-546.
4.	de Groat WC, Yoshimura N. Plasticity in reflex pathways to the lower urinary tract following spinal cord injury. Exp Neurol, 2012, 235(1): 123-132.
5.	林浩東, 侯春林, 鄭憲友, 等. 大鼠脊髓損傷后膀胱生理反射弧重建的實驗研究. 中國修復重建外科雜志, 2008, 22(6): 719-723.
6.	Lin H, Hou C. Transfer of normal S1 nerve root to reinnervate atonic bladder due to conus medullaris injury. Muscle Nerve, 2013, 47(2): 241-245.
7.	Zheng XY, Hou CL, Chen AM, et al. Optimal timing of operation for repairing atonic bladder after medullary cone injury: an experimental study in rats. Spinal Cord, 2008, 46(8): 574-581.
8.	王金武, 侯春林, 盧寧, 等. 利用腹壁反射重建膀胱反射弧的遠期功能性研究. 中華顯微外科雜志, 2002, 25(4): 280-284.
9.	胥維勇, 楊群, 范小莉. 介紹一種改良Masson三色染色法. 診斷病理學雜志, 2005, 12(1): 63．.
10.	de Groat WC, Wickens C. Organization of the neural switching circuitry underlying reflex micturition. Acta Physiol, 2013, 207(1): 66-84.
11.	Hoang TX, Pikov V, Havton LA, et al. Functional reinnervation of the rat lower urinary tract after cauda equina injury and repair. J Neurosci, 2006, 26(34): 8672-8679.
12.	趙繼懋, 張玉海, 杜林棟. 神經原性膀胱逼尿肌超微結構的變化. 中華泌尿外科雜志, 2004, 25(10): 682-685.
13.	Hindley RG, Brierly RD, McLarty E, et al. A qualitative ultrastructural study of the hypocontractile detrusor. J Urol, 2002, 168(1): 126-131.
14.	Miyazato M, Yoshimura N, Chancellor MB, et al. The other bladder syndrome: underactive bladder. Rev Urol, 2013, 15(1): 11-22.
15.	Chartier-Kastler E, Denys P. Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention. Neurourol Urodyn, 2011, 30(1): 21-31.
16.	Pannek J, Bertschy S. Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review. Spinal Cord, 2011, 49(10): 1028-1032.
17.	Jean-Jacques Wyndaele. Conservative treatment of patients with neurogenic bladder. European Urology Supplements, 2008, 7: 557-565.
18.	Lin H, Hou C, Chen A, et al. Reinnervation of atonic bladder after conus medullaris injury using a modified nerve crossover technique in canines. World Neurosurg, 2010, 73(5): 582-586.
19.	Lin H, Hou CL, Zhong G, et al. Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: Preliminary clinical result. Microsurgery, 2008, 28(6): 429-435.
20.	Lin H, Hou C, Zhen X. Bypassing spinal cord injury: surgical reconstruction of afferent and efferent pathways to the urinary bladder after conus medullaris injury in a rat model. J Reconstr Microsurg, 2008, 24(8): 575-581.
21.	Choi YS, Kim JC, Lee KS, et al. Analysis of female voiding dysfunction: a prospective, multi-center study. Int Urol Nephrol, 2013. [Epub ahead of print].
22.	侯春林, 鄭憲友, 陳愛民, 等. 大鼠脊髓圓錐損傷后膀胱逼尿肌及其神經肌肉接頭形態學變化的研究. 中國修復重建外科雜志, 2007, 21(5): 473-477.
23.	Smith PP, DeAngelis A, Kuchel GA. Detrusor expulsive strength is preserved, but responsiveness to bladder filling and urinary sensitivity is diminished in the aging mouse. Am J Physiol Regul Integr Comp Physiol, 2012, 302(5): R577-586.
24.	Pisarska-Krawczyk M, Urbaniak T, Klejewski A. Overactive bladder—diagnosis et treatment. Przegl Lek, 2012, 69(10): 1156-1159.
25.	Säily M, Vasarainen H, Sairanen J, et al. Urinary retention in women. Duodecim, 2012, 128(21): 2244-2250.

1. Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumber and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
2. Benevento BT, Sipski ML. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther, 2002, 82(6): 601-612.
3. Jeong SJ, Cho SY, Oh SJ. Spinal cord/brain injury and the neurogenic bladder. Urol Clin North Am, 2010, 37(4): 537-546.
4. de Groat WC, Yoshimura N. Plasticity in reflex pathways to the lower urinary tract following spinal cord injury. Exp Neurol, 2012, 235(1): 123-132.
5. 林浩東, 侯春林, 鄭憲友, 等. 大鼠脊髓損傷后膀胱生理反射弧重建的實驗研究. 中國修復重建外科雜志, 2008, 22(6): 719-723.
6. Lin H, Hou C. Transfer of normal S1 nerve root to reinnervate atonic bladder due to conus medullaris injury. Muscle Nerve, 2013, 47(2): 241-245.
7. Zheng XY, Hou CL, Chen AM, et al. Optimal timing of operation for repairing atonic bladder after medullary cone injury: an experimental study in rats. Spinal Cord, 2008, 46(8): 574-581.
8. 王金武, 侯春林, 盧寧, 等. 利用腹壁反射重建膀胱反射弧的遠期功能性研究. 中華顯微外科雜志, 2002, 25(4): 280-284.
9. 胥維勇, 楊群, 范小莉. 介紹一種改良Masson三色染色法. 診斷病理學雜志, 2005, 12(1): 63．.
10. de Groat WC, Wickens C. Organization of the neural switching circuitry underlying reflex micturition. Acta Physiol, 2013, 207(1): 66-84.
11. Hoang TX, Pikov V, Havton LA, et al. Functional reinnervation of the rat lower urinary tract after cauda equina injury and repair. J Neurosci, 2006, 26(34): 8672-8679.
12. 趙繼懋, 張玉海, 杜林棟. 神經原性膀胱逼尿肌超微結構的變化. 中華泌尿外科雜志, 2004, 25(10): 682-685.
13. Hindley RG, Brierly RD, McLarty E, et al. A qualitative ultrastructural study of the hypocontractile detrusor. J Urol, 2002, 168(1): 126-131.
14. Miyazato M, Yoshimura N, Chancellor MB, et al. The other bladder syndrome: underactive bladder. Rev Urol, 2013, 15(1): 11-22.
15. Chartier-Kastler E, Denys P. Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention. Neurourol Urodyn, 2011, 30(1): 21-31.
16. Pannek J, Bertschy S. Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review. Spinal Cord, 2011, 49(10): 1028-1032.
17. Jean-Jacques Wyndaele. Conservative treatment of patients with neurogenic bladder. European Urology Supplements, 2008, 7: 557-565.
18. Lin H, Hou C, Chen A, et al. Reinnervation of atonic bladder after conus medullaris injury using a modified nerve crossover technique in canines. World Neurosurg, 2010, 73(5): 582-586.
19. Lin H, Hou CL, Zhong G, et al. Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: Preliminary clinical result. Microsurgery, 2008, 28(6): 429-435.
20. Lin H, Hou C, Zhen X. Bypassing spinal cord injury: surgical reconstruction of afferent and efferent pathways to the urinary bladder after conus medullaris injury in a rat model. J Reconstr Microsurg, 2008, 24(8): 575-581.
21. Choi YS, Kim JC, Lee KS, et al. Analysis of female voiding dysfunction: a prospective, multi-center study. Int Urol Nephrol, 2013. [Epub ahead of print].
22. 侯春林, 鄭憲友, 陳愛民, 等. 大鼠脊髓圓錐損傷后膀胱逼尿肌及其神經肌肉接頭形態學變化的研究. 中國修復重建外科雜志, 2007, 21(5): 473-477.
23. Smith PP, DeAngelis A, Kuchel GA. Detrusor expulsive strength is preserved, but responsiveness to bladder filling and urinary sensitivity is diminished in the aging mouse. Am J Physiol Regul Integr Comp Physiol, 2012, 302(5): R577-586.
24. Pisarska-Krawczyk M, Urbaniak T, Klejewski A. Overactive bladder—diagnosis et treatment. Przegl Lek, 2012, 69(10): 1156-1159.
25. Säily M, Vasarainen H, Sairanen J, et al. Urinary retention in women. Duodecim, 2012, 128(21): 2244-2250.

《中國修復重建外科雜志》

脊髓圓錐損傷膀胱功能重建術后大鼠逼尿肌顯微結構變化研究

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《中國修復重建外科雜志》

脊髓圓錐損傷膀胱功能重建術后大鼠逼尿肌顯微結構變化研究

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