健侧骶神经移位修复骶丛撕脱伤的实验研究
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摘要
骨盆骨折常伴发骶丛损伤及骶丛撕脱伤,引起下肢运动、感觉功能障碍,并可能伴有排尿,排便功能障碍。但目前临床缺乏有效的治疗手段,因此,骶丛撕脱伤的研究成为了目前骨科临床研究的一大难点问题。为进一步探讨骶丛撕脱伤的病理改变及治疗,动物实验是必不可少的途径。鉴于大鼠在动物进化上比较接近人类,大鼠常被作为神经损伤和修复的理想动物模型。本文对大鼠骶丛结构及功能做了基础性研究,在不打开椎管建立大鼠骶丛撕脱伤模型基础上,以健侧L6神经根作为新的动力源神经修复骶丛撕脱伤,通过术后大鼠一般情况观察,肌肉的湿重对比,电镜,结合肌肉横断面免疫组化等指标综合分析以健侧L6神经根作为动力源神经修复骶丛撕脱伤的可行性及有效性。
第一部分SD大鼠动力源神经的选取
研究目的:分析大鼠骶丛及坐骨神经的神经根组成,并分析各神经根对肌肉的具体支配功能,选取适合的动力源神经。
研究方法:选用20只成年SD大鼠,雌雄不限,通过大体解剖了解坐骨神经的神经根组成;通过对L4-6神经根的刺激,分别检测股二头肌、小腿三头肌和胫前肌的肌电图,由此推断神经根对肌群的支配权重及定位关系。
结果:20只大鼠中,L4-6型有17只,L4-5型3只,两大类型又分两种亚型。L4-5是坐骨神经支配下肢肌肉的恒定支,L6神经根主要参与小腿三头肌的运动功能,但有3只大鼠,L6不参与对三组肌肉的支配。
结论:本实验基本明确了大鼠骶丛及坐骨神经的组成,利用肌电图的方法判定出大鼠下肢股二头肌、三头肌和胫前肌的神经根支配组成及权重,为选取适合的动力源神经奠定了基础
第二部分健侧L6神经根移位修复骶丛撕脱伤的实验研究
研究目的:探讨采用健侧L6神经根移位修复骶丛撕脱伤的实验的可行性及有效性。
研究方法:选用体重200-300g的成年SD大鼠共30只(复旦大学动物科学部提供),雌雄不限,随机分为3组(不吻合组、L6-L6吻合组、L6-L5吻合组)每组10只,右侧为实验侧,左侧为对照侧。术后观察各组大鼠的存活情况,对受试老鼠进行BBB评分;双侧股二头肌、小腿三头肌及胫前肌称重及肌肉横截面HE染色的对比研究;电镜检查吻合口远端神经生长情况;坐骨神经功能指数(SFI);肌电图检查(EMG)以评价吻合的有效性。
结果:术后12周BBB评分吻合组较不吻合组高,差异有统计学意义(P=0.001)。吻合组右侧的股二头肌、小腿三头肌、胫前肌与不吻合组相比均有不同程度恢复,差异有统计学意义。其中L6-L5吻合组效果较L6-L6吻合组好,三组肌群恢复速度在L6-L6吻合组内有差异,其中近侧股二头肌恢复效果相对较好,吻合口远端神经电镜观察可见大量再生有髓神经纤维。肌电图显示于三组肌肉可记录到波幅,其中以近侧股二头肌及小腿三头肌峰值较大,远侧胫前肌峰值较小。
结论:健侧L6神经根移位加自体神经移植或健侧L6神经根移位与患侧L5神经根直接吻合均能重建截瘫大鼠坐骨神经的部分功能,其中健侧L6神经根移位与患侧L5神经根吻合组效果优于健侧L6神经根移位加自体神经移植组。
Pelvic fracture is a common fracture in clinic, which may induce the Ventral rootavulsion.or ventral injury with the functional impairment of movement and feeling of lowerlimb. Nowadays, we have no efficient method to deal with them. To further study the injuryof sacral plexus root, we need animal experiments. Rat is the ideal model in the study ofsacral plexus root. in this article ,we emphasis on the animal researches of adopting thenormal sacral plexus root to Reconstruct the injured sacral plexus root. We use many ways toevaluate the the efficiency of this kind of therapy post-operation.
PartOne
Objective: To choose the ideal motor-nerve in rat.
Methods: 20 adult SD rats were dissected to discuss the rat sciatic nerve anatomy.17rats’s nerve roots of sciatic nerve are L4-6,While others are L4-5.and each tile has its twohypotypes. We also comfirmed that L4-5 is the permanent dominant nerve of biceps femoris,triceps surae and tibial muscle, and L6 is the main nerve dominant of triceps surae, but inthree rats, L6 has nothing to do with biceps femoris, triceps surae and tibial muscle.
Results: our results indicate that the components of the sciatic nerve vary from L4 toL6.we also confirm the biceps femoris, triceps surae and tibial muscle’s dominant nerve rootand contribution through EMG. So it builds a solid base of the choice of ideal motor-nerve .
PartTwo
Objective: To evaluate the efficiency of adopting L6 transposition to Reconstruct thesciatic nerve
Methods: 30 adult SD rats were chosen to establish the animal model of sacral plexusroot avulsion at random after avulsing the right L4-6 out of intervertebral foramina. rats weredivided into 3 groups(n=10). In one group rats we did not reconstruct the sciatic nerve. In twogroups we adopted the L6 transposition to Reconstruct the injured sacral plexus root. After themodel establishment, the autologous sacral plexus root nerve was bridged with the right L6 nerve root by the translocation of the left L6 in one group , while the right L5 nerve root nervewas bridged by the translocation of the left L6 in other group. 12 weeks after operation, rat ineach group were selected for the histomorphology of the nerves was observed under themicroscope and the electron microscope. the models were evaluated by the observation of thesurvival rates of the rates, BBB scores, electron microscope weight and muscle fiberCSA(cross section area) of double biceps femoris, triceps surae and tibial muscle.
Results: 12 week after operation, the BBB scores indicated significant differences(P=0.001)between 3 groups. We found remarkable significances between the ratio of weight and musclefiber CSA of double biceps femoris, triceps surae and tibial muscle. the Efficiency wasdifferent between the two groups (L6-L5 and L6-L6), the former was better. In the L6-L6 group,the recovery of biceps femoris, triceps surae and tibial muscle was different. The former wasbetter. The histomorphology of the nerves was observed under the microscope and the electromicroscope.
Conclusion: L6 transposition combined with autograft of nerve root or without theautograft can reconstruct the partial function of sciatic nerve the in paraplegia rats. The effectof non-graft is better than that of graft obviously.
第一部分SD大鼠动力源神经的选取
研究目的:分析大鼠骶丛及坐骨神经的神经根组成,并分析各神经根对肌肉的具体支配功能,选取适合的动力源神经。
研究方法:选用20只成年SD大鼠,雌雄不限,通过大体解剖了解坐骨神经的神经根组成;通过对L4-6神经根的刺激,分别检测股二头肌、小腿三头肌和胫前肌的肌电图,由此推断神经根对肌群的支配权重及定位关系。
结果:20只大鼠中,L4-6型有17只,L4-5型3只,两大类型又分两种亚型。L4-5是坐骨神经支配下肢肌肉的恒定支,L6神经根主要参与小腿三头肌的运动功能,但有3只大鼠,L6不参与对三组肌肉的支配。
结论:本实验基本明确了大鼠骶丛及坐骨神经的组成,利用肌电图的方法判定出大鼠下肢股二头肌、三头肌和胫前肌的神经根支配组成及权重,为选取适合的动力源神经奠定了基础
第二部分健侧L6神经根移位修复骶丛撕脱伤的实验研究
研究目的:探讨采用健侧L6神经根移位修复骶丛撕脱伤的实验的可行性及有效性。
研究方法:选用体重200-300g的成年SD大鼠共30只(复旦大学动物科学部提供),雌雄不限,随机分为3组(不吻合组、L6-L6吻合组、L6-L5吻合组)每组10只,右侧为实验侧,左侧为对照侧。术后观察各组大鼠的存活情况,对受试老鼠进行BBB评分;双侧股二头肌、小腿三头肌及胫前肌称重及肌肉横截面HE染色的对比研究;电镜检查吻合口远端神经生长情况;坐骨神经功能指数(SFI);肌电图检查(EMG)以评价吻合的有效性。
结果:术后12周BBB评分吻合组较不吻合组高,差异有统计学意义(P=0.001)。吻合组右侧的股二头肌、小腿三头肌、胫前肌与不吻合组相比均有不同程度恢复,差异有统计学意义。其中L6-L5吻合组效果较L6-L6吻合组好,三组肌群恢复速度在L6-L6吻合组内有差异,其中近侧股二头肌恢复效果相对较好,吻合口远端神经电镜观察可见大量再生有髓神经纤维。肌电图显示于三组肌肉可记录到波幅,其中以近侧股二头肌及小腿三头肌峰值较大,远侧胫前肌峰值较小。
结论:健侧L6神经根移位加自体神经移植或健侧L6神经根移位与患侧L5神经根直接吻合均能重建截瘫大鼠坐骨神经的部分功能,其中健侧L6神经根移位与患侧L5神经根吻合组效果优于健侧L6神经根移位加自体神经移植组。
Pelvic fracture is a common fracture in clinic, which may induce the Ventral rootavulsion.or ventral injury with the functional impairment of movement and feeling of lowerlimb. Nowadays, we have no efficient method to deal with them. To further study the injuryof sacral plexus root, we need animal experiments. Rat is the ideal model in the study ofsacral plexus root. in this article ,we emphasis on the animal researches of adopting thenormal sacral plexus root to Reconstruct the injured sacral plexus root. We use many ways toevaluate the the efficiency of this kind of therapy post-operation.
PartOne
Objective: To choose the ideal motor-nerve in rat.
Methods: 20 adult SD rats were dissected to discuss the rat sciatic nerve anatomy.17rats’s nerve roots of sciatic nerve are L4-6,While others are L4-5.and each tile has its twohypotypes. We also comfirmed that L4-5 is the permanent dominant nerve of biceps femoris,triceps surae and tibial muscle, and L6 is the main nerve dominant of triceps surae, but inthree rats, L6 has nothing to do with biceps femoris, triceps surae and tibial muscle.
Results: our results indicate that the components of the sciatic nerve vary from L4 toL6.we also confirm the biceps femoris, triceps surae and tibial muscle’s dominant nerve rootand contribution through EMG. So it builds a solid base of the choice of ideal motor-nerve .
PartTwo
Objective: To evaluate the efficiency of adopting L6 transposition to Reconstruct thesciatic nerve
Methods: 30 adult SD rats were chosen to establish the animal model of sacral plexusroot avulsion at random after avulsing the right L4-6 out of intervertebral foramina. rats weredivided into 3 groups(n=10). In one group rats we did not reconstruct the sciatic nerve. In twogroups we adopted the L6 transposition to Reconstruct the injured sacral plexus root. After themodel establishment, the autologous sacral plexus root nerve was bridged with the right L6 nerve root by the translocation of the left L6 in one group , while the right L5 nerve root nervewas bridged by the translocation of the left L6 in other group. 12 weeks after operation, rat ineach group were selected for the histomorphology of the nerves was observed under themicroscope and the electron microscope. the models were evaluated by the observation of thesurvival rates of the rates, BBB scores, electron microscope weight and muscle fiberCSA(cross section area) of double biceps femoris, triceps surae and tibial muscle.
Results: 12 week after operation, the BBB scores indicated significant differences(P=0.001)between 3 groups. We found remarkable significances between the ratio of weight and musclefiber CSA of double biceps femoris, triceps surae and tibial muscle. the Efficiency wasdifferent between the two groups (L6-L5 and L6-L6), the former was better. In the L6-L6 group,the recovery of biceps femoris, triceps surae and tibial muscle was different. The former wasbetter. The histomorphology of the nerves was observed under the microscope and the electromicroscope.
Conclusion: L6 transposition combined with autograft of nerve root or without theautograft can reconstruct the partial function of sciatic nerve the in paraplegia rats. The effectof non-graft is better than that of graft obviously.
引文
[1] Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997, 28(9-10): 674-678
[2] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient[J].Orthopedics, 2003, 26(1): 89-90
[3]顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志, 2002,4(3): 174-177
[4] Bellabarba C, Schildhauer TA, Vaccaro AR, et al. Complications associated with surgicalstabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine, 2006, 31(11Suppl): S80-88
[5] Barnett HG, Connolly ES. Lumbosacral nerve root avulsion: report of a case and review of theliterature. J Trauma, 1975, 15(6): 532-535
[6] Maillard J C, Zouaoui A, Bencherif B, Bouayed N, Chedid G, Marsault C. Imaging in theexploration of lumbosacral plexus avulsion. Two cases. J Neuroradiol. 1992, 19(1): 38-48
[7] Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortem radiographic andpatho-anatomical study. Acta Chir Scand Suppl, 1972, 429: 3-43
[8]陈爱民,侯春林,苟三怀,欧阳跃平,刘岩,张伟.开放性骨盆骨折:治疗对策与疗效分析.上海市医学会骨科学术年会论文汇编.上海, 2007: 18-19
[9] Monga P, Ahmed A, Gupta GR, Rao KS. Traumatic lumbar nerve root avulsion: evaluation usingelectrodiagnostic studies and magnetic resonance myelography. J Trauma, 2004, 56(1): 182-184
[10] Alexandre A, CoròL, Azuelos A. Microsurgical treatment of lumbosacral plexus injuries. ActaNeurochir Suppl, 2005, 92: 53-59
[11] Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J NeurosurgSpine, 2004, 1(1): 64-71
[12]顾玉东,张高盂,陈德松,等.健侧颈7神经根移位术治疗臂丛根性撕脱伤.中华医学杂志,1989, 69: 563-566
[13] Lou L, Shou T, Li Z, Li W, Gu Y. Transhemispheric functional reorganization of the motorcortex induced by the peripheral contralateral nerve transfer to the injured arm.Neuroscience,2006,138(4): 1225-1231
[14]高凯鸣,劳杰,顾玉东,张丽银,虞聪,赵新.健侧颈7移位术后的远期功能随访.中华手外科杂志, 2006, 22(4): 195-197
[15]徐瑞生,侯春林,张世民,金武,王诗波,刘明轩,陈爱民.“膝腱-脊髓-膀胱”反射弧的形态学观察.中国脊柱脊髓杂志, 2002, 12(4): 273-276
[16]侯春林,王诗波,陈爱民,徐瑞生,衷鸿宾,张世民,张伟,匡勇,尹承慧.利用跟腱反射建立人工膀胱反射弧的临床研究.解放军医学杂志, 2003, 28(8): 668-669
[17]侯春林,王金武,陈爱民,张伟,卢宁,曹银祥.利用腹壁反射重建人工膀胱反射弧的实验研究.上海医学, 2003, 26(2): 102-104
[18]侯春林,衷鸿宾,张世民,陈爱民,刘祖德,刘明轩,徐瑞生,王永胜,尹承慧.建立人工膀胱反射弧恢复脊髓损伤患者排尿功能的初步报告.第二军医大学学报, 2000, 21(1): 87-89
[19]徐镇,侯春林,张伟,陈爱民,郑宪友,王剑火.利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察.中华外科杂志, 2008, 46(3): 221-223
[20]杨安峰,王平.大鼠的解剖和组织.北京:科学出版社, 1985, 178-178
[21]蒋正揆.运动学实验方法.上海:上海科学技术出版社, 1984, 181-189
[22] Hebel R, Stormberg MW. Anatomy and Embryology of the laboratory Rat. Biomed VerlagGermany, 1986, 182-184
[23] Katagiri T, Gibson SJ, Su HC, Polak JM. Composition and central projection of the pudendalnerve in the rat investigated by combined peptide in immunocytochemistry and retrograde fluorescentlabeling. Brain res,1986, 313-322, 372
[24] Asato F, Butler M, Blomberg H, Gordh T. Variation in rat sciatic nerve anatomy: implications fora rat model of neuropathic pain. J Peripher Nerv Syst. 2000, 5(1): 19-21
[25]曹学成.大鼠坐骨神经的解剖学研究.中国实验动物学杂志, 2002, 12(4): 213-214
[26]卢能祖,曾庆杏,李曾宴.实用肌电图学.北京:人民卫生出版社, 2000, 194-206, 420-427
[27]顾玉东,沈丽英,沈尊理,德松,成效敏,张丽银,蔡佩琴,陈高.臂丛神经根支配功能的电生理研究.中华外科杂志, 1996, 34(1): 40-43
[28]徐峰,傅中国,张殿英,褚亚明,姜保国.腰神经根与其支配肌群的电生理定位实验.中国临床康复, 2006, 7(26): 16-18
[29] Phillips IJH 2nd, Park TS.Electrophysiologic mapping of the segmental anatomy of the musclesof the lower extremity.Muscle Nen, 1991, 14(12): 1213-1218
[30] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003, 26(1): 89-90
[31] Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J NeurosurgSpine, 2004, 1(1): 64-71
[32] Hare GM, Evans PJ, Mackinnon SE, Best TJ, Bain JR, Szalai JP, Hunter DA.. Walking trackanalysis: a long-term assessment of peripheral nerve recovery. Plast Reconstr Surg, 1992, 89(2): 251-258
[33] Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997, 28(9-10): 674-678
[34] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003, 26(1): 89-90
[35]顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002, 4(3): 174-177
1.Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury. 1997 ;28(9-10):674-678.
2.Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatricpatient[J]. Orthopedics. 2003,26(1):89-90.
3.顾立强,张景僚,王钢,等.骨盆骨折合并腰骶丛损伤的诊治[J].中华创伤骨科杂志.2002,4(3):174-177.
4. Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR. Complications associatedwith surgical stabilization of high-grade sacral fracture dislocations with spino-pelvicinstability.Spine. 2006,31(11 Suppl):S80-8; discussion S104.
5. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report of a case andreview of the literature[J]. J Trauma.1975,15: 532-5。
6.Maillard J. C., Zouaoui A., Bencherif B., Bouayed N., Chedid G. and Marsault C.Imaging in the exploration of lumbosacral plexus avulsion[J]. J Neuroradiol.1992,19: 38.
7. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortemradiographic and patho-anatomical study[J]. Acta Chir Scand. 1972,429 Suppl:3-43.
8.陈爱民,侯春林,苟三怀,欧阳跃平,刘岩,张伟,等.开放性骨盆骨折:治疗对策与疗效分析.上海市医学会骨科学术年会论文汇编2007年8月,pp18-19.
9.Monga P, Ahmed A, Gupta GR, Rao KS. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonance myelography[J]. J Trauma.2004,56(1):182-184.
10. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J].J Neurosurg Spine.2004,1(1):64-71.
11.顾玉东,张高盂.陈德松,等.健侧颈7神经根移位术治疗臂丛根性撕脱伤.中华医学杂志,1989,69:563-566.
12. Lou L.Shou T,Li Z,et a1.Transhemispheric functional reorganization of the motorcortex induced by the peripheral contralateral nerve transfer to the injuredarm[J].Neuroscience.20O6,l38:l225-1231.
13.高凯鸣,劳杰,顾玉东,等.健侧颈7移位术后的远期功能随访[J].中华手外科杂志.2006;22(4):195-197.
14. Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A. Latero-terminal neurorrhaphywithout removal of the epineural sheath. Experimental study in rats. Rev PaulMed.1992,110(6):267-275.
15.Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns JM. Can sensory and motorcollateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? JHand Surg [Br].1994,19(3):277-282.
16.张东旺,罗永湘.周围神经端侧缝合后侧支神经再生的研究进展[J].中华骨科杂志.1999,l9(1I):690-692.
17.洪光祥,郑毅,王发斌,等.周围神经端侧吻合后神经再生的研究.中华手外科杂志.1998,l4(1):42-44.
18. Viterbo F.A new method for treatment of facial palsy:The cross-face nervetransplantation with end to side neurorraphy.Rev Soc Bras Cir Plast Est Reconst.l993,8:29—35.
19. Cao XC, Ling LJ. Anatomic basis and technical aspects of a new brachial plexusavulsion injury model in the rat.Plast Reconstr Surg. 2003 Jun;111(7):2488-2490.
20.郑圣鼐,张高孟,顾玉东,等.颈胸椎前路和后路手术制作大鼠臂丛根性撕脱伤模型探讨.中华显微外科杂志,2003,26(4): 291-292.
21. Koliatsos VE, Price WL, Pardo CA, Price DL. Ventral root avulsion: an experimentalmodel of death of adult motor neurons. J Comp Neurol.1994,342(1):35-44.
22.王金武;侯春林;陈爱民;王诗波;赵良宇. SD大鼠马尾与骶神经根的解剖学观察[J].中国临床解剖学杂志; 2003; 21(4): 368-370.
23.郑宪友,顾玉东,史其林,李继峰,孙贵新,周琳.大鼠单纯臂丛下干损伤屈指功能重建动物模型的探讨[J].中华显微外科杂志;2005;28(1):52-54.
24. Alexandre A, Coro L, Azuelos A. Microsurgical treatment of lumbosacral plexusinjuries. Acta Neurochir Suppl,2005,92:53-59.
1 Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003; 26(1):89-90
2 Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997; 28(9-10):674-678
3顾立强,张景僚,王钢,等.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002; 4(3):174-177
4 Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospectiveanalysis of 236 cases. Clin Orthop,1988; 227:67-81
5 Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997; 28(9-10):674-678
6 Barnett HG, Connolly ES. Lumbosacral nerve root avulsion: report of a case and reviewof the literature. J Trauma, 1975; 15(6):532-535
7 Maillard JC, Zouaoui A, Bencherif B, et al. Imaging in the exploration of lumbosacralplexus avulsion. J Neuroradiol, 1992; 19(1):38-48
8 Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortemradiographic and patho-anatomical study. Acta Chir Scand Suppl, 1972; 429:3-43
9 Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion: evaluationusing electrodiagnostic studies and magnetic resonance myelography. J Trauma, 2004;56(1):182-184
10 Pohlemann T, Gansslen A, Tscherne H. The problem of the sacrum fracture. Clinicalanalysis of 377 cases. Orthopade, 1992; 21(6):400-412
11 Bellabarba C, Stewart JD, Ricci WM, et al. Midline sagittal sacral fractures inanterior-posterior compression pelvic ring injuries. J Orthop Trauma, 2003; 17(1):32-37
12 Chiodo A. Neurologic injury associated with pelvic trauma: radiology andelectrodiagnosis evaluation and their relationships to pain and gait outcome. Arch PhysMed Rehabil, 2007; 88(9):1171-1176
13 Sasaka KK, Phisitkul P, Boyd JL, et al. Lumbosacral nerve root avulsions: MR imagingdemonstration of acute abnormalities. Am J Neuroradiol, 2006; 27(9)(10):1944-1946
14 Streiter ML, Chambers AA. Metrizamide examination of traumatic lumbar nerve rootmeningocele. Spine, 1984; 9(1):77-78
15 Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. JNeurosurg Spine, 2004; 1(1):64-71
16 Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacral plexopathy.Case report and review of the literature. J Neurosurg, 2005; 102(1 Suppl):86-91
17 Hoang TX, Nieto JH, Dobkin BH, et al. Acute implantation of an avulsed lumbosacralventral root into the rat conus medullaris promotes neuroprotection and graftreinnervation by autonomic and motor neurons. Neuroscience, 2006; 138(4):1149-1160
18 Azuelos A, CoròL, Alexandre A. Femoral nerve entrapment[A].In: Alexandre A, BricoloA, Millesi H, eds. Advanced Peripheral Nerve Surgery and Minimal Invasive SpinalSurgery(Acta Neurochirurgica Supplements)[M]. Vol 97, New York: Springer,2006:61-62
19徐镇,侯春林,张伟,等.利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察.中华外科杂志, 2008; 46(3):221-223
[2] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient[J].Orthopedics, 2003, 26(1): 89-90
[3]顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志, 2002,4(3): 174-177
[4] Bellabarba C, Schildhauer TA, Vaccaro AR, et al. Complications associated with surgicalstabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine, 2006, 31(11Suppl): S80-88
[5] Barnett HG, Connolly ES. Lumbosacral nerve root avulsion: report of a case and review of theliterature. J Trauma, 1975, 15(6): 532-535
[6] Maillard J C, Zouaoui A, Bencherif B, Bouayed N, Chedid G, Marsault C. Imaging in theexploration of lumbosacral plexus avulsion. Two cases. J Neuroradiol. 1992, 19(1): 38-48
[7] Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortem radiographic andpatho-anatomical study. Acta Chir Scand Suppl, 1972, 429: 3-43
[8]陈爱民,侯春林,苟三怀,欧阳跃平,刘岩,张伟.开放性骨盆骨折:治疗对策与疗效分析.上海市医学会骨科学术年会论文汇编.上海, 2007: 18-19
[9] Monga P, Ahmed A, Gupta GR, Rao KS. Traumatic lumbar nerve root avulsion: evaluation usingelectrodiagnostic studies and magnetic resonance myelography. J Trauma, 2004, 56(1): 182-184
[10] Alexandre A, CoròL, Azuelos A. Microsurgical treatment of lumbosacral plexus injuries. ActaNeurochir Suppl, 2005, 92: 53-59
[11] Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J NeurosurgSpine, 2004, 1(1): 64-71
[12]顾玉东,张高盂,陈德松,等.健侧颈7神经根移位术治疗臂丛根性撕脱伤.中华医学杂志,1989, 69: 563-566
[13] Lou L, Shou T, Li Z, Li W, Gu Y. Transhemispheric functional reorganization of the motorcortex induced by the peripheral contralateral nerve transfer to the injured arm.Neuroscience,2006,138(4): 1225-1231
[14]高凯鸣,劳杰,顾玉东,张丽银,虞聪,赵新.健侧颈7移位术后的远期功能随访.中华手外科杂志, 2006, 22(4): 195-197
[15]徐瑞生,侯春林,张世民,金武,王诗波,刘明轩,陈爱民.“膝腱-脊髓-膀胱”反射弧的形态学观察.中国脊柱脊髓杂志, 2002, 12(4): 273-276
[16]侯春林,王诗波,陈爱民,徐瑞生,衷鸿宾,张世民,张伟,匡勇,尹承慧.利用跟腱反射建立人工膀胱反射弧的临床研究.解放军医学杂志, 2003, 28(8): 668-669
[17]侯春林,王金武,陈爱民,张伟,卢宁,曹银祥.利用腹壁反射重建人工膀胱反射弧的实验研究.上海医学, 2003, 26(2): 102-104
[18]侯春林,衷鸿宾,张世民,陈爱民,刘祖德,刘明轩,徐瑞生,王永胜,尹承慧.建立人工膀胱反射弧恢复脊髓损伤患者排尿功能的初步报告.第二军医大学学报, 2000, 21(1): 87-89
[19]徐镇,侯春林,张伟,陈爱民,郑宪友,王剑火.利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察.中华外科杂志, 2008, 46(3): 221-223
[20]杨安峰,王平.大鼠的解剖和组织.北京:科学出版社, 1985, 178-178
[21]蒋正揆.运动学实验方法.上海:上海科学技术出版社, 1984, 181-189
[22] Hebel R, Stormberg MW. Anatomy and Embryology of the laboratory Rat. Biomed VerlagGermany, 1986, 182-184
[23] Katagiri T, Gibson SJ, Su HC, Polak JM. Composition and central projection of the pudendalnerve in the rat investigated by combined peptide in immunocytochemistry and retrograde fluorescentlabeling. Brain res,1986, 313-322, 372
[24] Asato F, Butler M, Blomberg H, Gordh T. Variation in rat sciatic nerve anatomy: implications fora rat model of neuropathic pain. J Peripher Nerv Syst. 2000, 5(1): 19-21
[25]曹学成.大鼠坐骨神经的解剖学研究.中国实验动物学杂志, 2002, 12(4): 213-214
[26]卢能祖,曾庆杏,李曾宴.实用肌电图学.北京:人民卫生出版社, 2000, 194-206, 420-427
[27]顾玉东,沈丽英,沈尊理,德松,成效敏,张丽银,蔡佩琴,陈高.臂丛神经根支配功能的电生理研究.中华外科杂志, 1996, 34(1): 40-43
[28]徐峰,傅中国,张殿英,褚亚明,姜保国.腰神经根与其支配肌群的电生理定位实验.中国临床康复, 2006, 7(26): 16-18
[29] Phillips IJH 2nd, Park TS.Electrophysiologic mapping of the segmental anatomy of the musclesof the lower extremity.Muscle Nen, 1991, 14(12): 1213-1218
[30] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003, 26(1): 89-90
[31] Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J NeurosurgSpine, 2004, 1(1): 64-71
[32] Hare GM, Evans PJ, Mackinnon SE, Best TJ, Bain JR, Szalai JP, Hunter DA.. Walking trackanalysis: a long-term assessment of peripheral nerve recovery. Plast Reconstr Surg, 1992, 89(2): 251-258
[33] Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997, 28(9-10): 674-678
[34] Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003, 26(1): 89-90
[35]顾立强,张景僚,王钢,裴国献.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002, 4(3): 174-177
1.Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury. 1997 ;28(9-10):674-678.
2.Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatricpatient[J]. Orthopedics. 2003,26(1):89-90.
3.顾立强,张景僚,王钢,等.骨盆骨折合并腰骶丛损伤的诊治[J].中华创伤骨科杂志.2002,4(3):174-177.
4. Bellabarba C, Schildhauer TA, Vaccaro AR, Chapman JR. Complications associatedwith surgical stabilization of high-grade sacral fracture dislocations with spino-pelvicinstability.Spine. 2006,31(11 Suppl):S80-8; discussion S104.
5. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report of a case andreview of the literature[J]. J Trauma.1975,15: 532-5。
6.Maillard J. C., Zouaoui A., Bencherif B., Bouayed N., Chedid G. and Marsault C.Imaging in the exploration of lumbosacral plexus avulsion[J]. J Neuroradiol.1992,19: 38.
7. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortemradiographic and patho-anatomical study[J]. Acta Chir Scand. 1972,429 Suppl:3-43.
8.陈爱民,侯春林,苟三怀,欧阳跃平,刘岩,张伟,等.开放性骨盆骨折:治疗对策与疗效分析.上海市医学会骨科学术年会论文汇编2007年8月,pp18-19.
9.Monga P, Ahmed A, Gupta GR, Rao KS. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonance myelography[J]. J Trauma.2004,56(1):182-184.
10. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J].J Neurosurg Spine.2004,1(1):64-71.
11.顾玉东,张高盂.陈德松,等.健侧颈7神经根移位术治疗臂丛根性撕脱伤.中华医学杂志,1989,69:563-566.
12. Lou L.Shou T,Li Z,et a1.Transhemispheric functional reorganization of the motorcortex induced by the peripheral contralateral nerve transfer to the injuredarm[J].Neuroscience.20O6,l38:l225-1231.
13.高凯鸣,劳杰,顾玉东,等.健侧颈7移位术后的远期功能随访[J].中华手外科杂志.2006;22(4):195-197.
14. Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A. Latero-terminal neurorrhaphywithout removal of the epineural sheath. Experimental study in rats. Rev PaulMed.1992,110(6):267-275.
15.Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns JM. Can sensory and motorcollateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? JHand Surg [Br].1994,19(3):277-282.
16.张东旺,罗永湘.周围神经端侧缝合后侧支神经再生的研究进展[J].中华骨科杂志.1999,l9(1I):690-692.
17.洪光祥,郑毅,王发斌,等.周围神经端侧吻合后神经再生的研究.中华手外科杂志.1998,l4(1):42-44.
18. Viterbo F.A new method for treatment of facial palsy:The cross-face nervetransplantation with end to side neurorraphy.Rev Soc Bras Cir Plast Est Reconst.l993,8:29—35.
19. Cao XC, Ling LJ. Anatomic basis and technical aspects of a new brachial plexusavulsion injury model in the rat.Plast Reconstr Surg. 2003 Jun;111(7):2488-2490.
20.郑圣鼐,张高孟,顾玉东,等.颈胸椎前路和后路手术制作大鼠臂丛根性撕脱伤模型探讨.中华显微外科杂志,2003,26(4): 291-292.
21. Koliatsos VE, Price WL, Pardo CA, Price DL. Ventral root avulsion: an experimentalmodel of death of adult motor neurons. J Comp Neurol.1994,342(1):35-44.
22.王金武;侯春林;陈爱民;王诗波;赵良宇. SD大鼠马尾与骶神经根的解剖学观察[J].中国临床解剖学杂志; 2003; 21(4): 368-370.
23.郑宪友,顾玉东,史其林,李继峰,孙贵新,周琳.大鼠单纯臂丛下干损伤屈指功能重建动物模型的探讨[J].中华显微外科杂志;2005;28(1):52-54.
24. Alexandre A, Coro L, Azuelos A. Microsurgical treatment of lumbosacral plexusinjuries. Acta Neurochir Suppl,2005,92:53-59.
1 Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatric patient.Orthopedics, 2003; 26(1):89-90
2 Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997; 28(9-10):674-678
3顾立强,张景僚,王钢,等.骨盆骨折合并腰骶丛损伤的诊治.中华创伤骨科杂志,2002; 4(3):174-177
4 Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospectiveanalysis of 236 cases. Clin Orthop,1988; 227:67-81
5 Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury, 1997; 28(9-10):674-678
6 Barnett HG, Connolly ES. Lumbosacral nerve root avulsion: report of a case and reviewof the literature. J Trauma, 1975; 15(6):532-535
7 Maillard JC, Zouaoui A, Bencherif B, et al. Imaging in the exploration of lumbosacralplexus avulsion. J Neuroradiol, 1992; 19(1):38-48
8 Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortemradiographic and patho-anatomical study. Acta Chir Scand Suppl, 1972; 429:3-43
9 Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion: evaluationusing electrodiagnostic studies and magnetic resonance myelography. J Trauma, 2004;56(1):182-184
10 Pohlemann T, Gansslen A, Tscherne H. The problem of the sacrum fracture. Clinicalanalysis of 377 cases. Orthopade, 1992; 21(6):400-412
11 Bellabarba C, Stewart JD, Ricci WM, et al. Midline sagittal sacral fractures inanterior-posterior compression pelvic ring injuries. J Orthop Trauma, 2003; 17(1):32-37
12 Chiodo A. Neurologic injury associated with pelvic trauma: radiology andelectrodiagnosis evaluation and their relationships to pain and gait outcome. Arch PhysMed Rehabil, 2007; 88(9):1171-1176
13 Sasaka KK, Phisitkul P, Boyd JL, et al. Lumbosacral nerve root avulsions: MR imagingdemonstration of acute abnormalities. Am J Neuroradiol, 2006; 27(9)(10):1944-1946
14 Streiter ML, Chambers AA. Metrizamide examination of traumatic lumbar nerve rootmeningocele. Spine, 1984; 9(1):77-78
15 Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. JNeurosurg Spine, 2004; 1(1):64-71
16 Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacral plexopathy.Case report and review of the literature. J Neurosurg, 2005; 102(1 Suppl):86-91
17 Hoang TX, Nieto JH, Dobkin BH, et al. Acute implantation of an avulsed lumbosacralventral root into the rat conus medullaris promotes neuroprotection and graftreinnervation by autonomic and motor neurons. Neuroscience, 2006; 138(4):1149-1160
18 Azuelos A, CoròL, Alexandre A. Femoral nerve entrapment[A].In: Alexandre A, BricoloA, Millesi H, eds. Advanced Peripheral Nerve Surgery and Minimal Invasive SpinalSurgery(Acta Neurochirurgica Supplements)[M]. Vol 97, New York: Springer,2006:61-62
19徐镇,侯春林,张伟,等.利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察.中华外科杂志, 2008; 46(3):221-223