SD大鼠腰2移位修复骶丛撕脱伤的实验研究
|
摘要
随着现代工业和交通的发展，人们的旅行速度越来越快，严重的交通伤害和工业伤害也增加了起来。这其中不乏严重的骨盆骨折。由于骨盆骨折等所导致的骶丛神经根性撕脱伤（腰4，腰5及骶1-4）也随之而来。对于骶丛撕脱伤的治疗，目前并无十分有效的手段。长期以来，业界对于骶丛撕脱伤的治疗一直采取保守疗法1。近年来，有少数学者尝试采用外科方法治疗2,3，采用的方法主要是对骶丛神经进行探查，如有可能，也进行原位的残端吻合，这种情况下，患者的恢复非常有限。陈爱民等提出采用健侧的骶1神经根作为新的动力源神经移位修复骶丛撕脱伤，并初步证实其作为动力源神经治疗的安全性和部分有效性4。但是临床上的骶丛损伤患者一般是多根神经根同时受损，而单一的骶1神经根仅能修复一支神经根。所以，我们需要更多的动力源神经来同时进行骶丛损伤的修复，才有望提高恢复水平。腰丛作为动力源神经已经应用于脊髓损伤后的膀胱功能重建5，且由于腰神经根在后路比较容易暴露，和骶丛位置邻近，手术创伤相对小，课题组在对大鼠解剖结构参数观测的基础上，已成功建立骶丛撕脱伤模型，通过术后观察大鼠的生存率、大鼠行为学观察及电生理检测来判断L2作为动力源神经的安全性。通过行为学观察，电生理检查、肌肉的湿重对比、电镜观察并结合肌肉横断面免疫组化判断神经根移位术后神经再生情况，证实其有效性。通过造模术后大鼠一般情况观察、肌肉的湿重比，电镜观察、结合肌肉横断面免疫组化，脊髓前角运动细胞元凋亡等指标综合分析骶丛撕脱伤后靶肌肉退变规律。
第一部分腰2神经根作为动力源神经的安全性研究
目的：了解切取单根腰2神经根对一侧肢体的影响，以及术后靶细胞退变规律的研究。
方法：选取60只成年SD大鼠，雌雄不限，不打开椎管，在椎体神经孔外侧切断右侧腰4-腰6神经根，术后通过体感诱发电位来进行筛选，剔除造模不成功的大鼠，另取大鼠造模补足数量。将造模成功的大鼠分为3组，第一组为假手术对照组；第二组将大鼠的健侧腰2在椎管外切断；第三组将大鼠健侧腰2及腰6同时在椎管外切断。术后观察三组大鼠的一般情况，生存率，进行行为学观察和测试以及电生理检查。
结果：1、一般情况：术后16周，三组大鼠分别存活19只、18只、18只；2、16周时三组大鼠左侧BBB评分分别为10.92±3.14、10.69±3.29、10.38±3.77；3、第一组及第二组大鼠均未发现有健侧肢体溃疡和自噬现象，第三组有一只大鼠出现轻微的足底溃疡，后愈合。
结论：以腰2神经根作为动力源神经是安全可靠的，但是同时采用健侧的腰2及腰6神经根作为动力源神经可能会在早期有个别的出现难以代偿的失神经现象。
第二部分利用腰2修复骶丛神经撕脱伤的研究
目的：评价采用腰2作为动力源神经去修复骶丛撕脱伤的有效性。
方法：选用已成年的200-300g的SD大鼠共90只，雄雌不限，进行右侧骶丛撕脱伤造模，术后通过SEP健侧剔除造模不成功的大鼠，另取大鼠造模补足数量。将大鼠随机分为三组，分别为假手术组、健侧腰2-伤侧腰6吻合组、健侧腰6-伤侧腰6吻合组。术后观察各组大鼠的存活情况，对大鼠进行BBB评分；双侧股二头肌、小腿三头肌及胫前肌称量湿重和观察到的肌肉横断面对比和比较HE染色，电镜观察神经远端吻合口增长;利用肌电图来评估一贯作业的有效性。
结果：术后12周BBB评分显示，两吻合组得分均高于假手术组，差异有统计学意义，两吻合组之间无明显差异。吻合组患侧的胫前肌、小腿三头肌及股二头肌与不吻合组比较，有明显的恢复，差异有统计学意义。吻合组内三组肌肉尤其以股二头肌恢复为佳。
结论：健侧腰2神经根移位是能够有效的进行骶丛撕脱伤修复的动力源神经，能够解决由于无法找到神经根残端而无法修复的困难或者动力源神经不足时候的有效补充。
第三部分大鼠单侧骶丛撕脱伤后靶肌肉退变规律的研究
目的：研究单侧骶丛撕脱伤后靶肌肉的退变规律。
方法：选用体重200-300g的成年SD大鼠60只，雄雌不限，建立单侧骶丛撕脱伤模型，。分别于损伤后2周，4周，6周，8周，10周，12周取大鼠两侧的小腿三头肌，测量肌肉湿重、肌细胞直径及肌肉横截面积及观察运动终板形态。
结果：在肌肉失神经支配后，肌肉湿重、肌细胞直径及肌肉横截面积均下降，其中肌细胞直径及肌肉横截面积均呈进行性下降过程，而肌肉湿重呈现前快后慢的下降过程。在4周内，运动终板无明显变化，4周后，其边缘开始变得模糊，进而消失，12周基本很难找到。
结论：肌肉湿重、肌细胞直径及肌肉横截面积均出现下降，运动终板在4周后开始逐渐消失。
第四部分骶丛撕脱伤修复后中枢重建规律的研究
目的：研究单侧骶丛撕脱伤健侧腰2移位后中枢重建规律。
方法：选用体重200-300g的成年SD大鼠30只，雄雌不限，将其随机分为3组：第一组：右侧骶丛撕脱伤损伤不修复组，为阴性对照组，10只；第二组：健侧L2神经根移位修复组，10只；第三组：假手术组，不做特殊处理，10只。术后4个月，大鼠禁食12小时，尾静脉注射0.2ml18F-FDG，同时持续电刺激右侧患肢，吸收40分钟后上机扫描，扫描视野包括大鼠整个脑部及颈部。
结果：第一组大鼠脑部基本无明显显像，第二组大鼠脑部双侧均有显像，第三组大鼠左侧脑部显像较为明显。
结论：神经根移位成功，大脑皮层功能区的定位会发生重建。
Nowadays, people travel faster than before. So, severe trafficinjuries increase. Pelvic fracture becomes common in the clinical work.Ventral root avulsion or ventral injury arisen from pelvic fracture comessubsequently. We have no efficient methods to deal with them. For a longperiod, conservative treatment was the first choice for this kind ofinjuries. In recent years, some doctors tried surgeries. The most adoptedmethod was ventral nerves exploration. Patients could hardly getsatisfied outcome. CHEN Aimin et al. used the contralateral L1root asa power source nerve to repair sacral root avulsion, and they had primarilyconfirmed its security and validity. Then a new problem occurred, we needmore power source nerves for the repair. Lumbar plexus may be a idealchoice. After operation, We used to evaluate many aspects of theeffectiveness of this method of treatment.
Part one
Objective: to evaluate the security of cutting L2as a power sourcenerve and find out the degeneration law of the target cell.
Method: sixty adult SD rats were chosen at random to establish thesacral nerve root models by avulsing the right side of L4-L6rat nerveroots of the intervertebral foramen without laminectomy. These rats weredivided into three groups at random, group1was control group (sham group),L2nerve roots of rats in group2were cut off outside the intervertebralforamina, and L2and L6nerve roots of rats in group3were cut off outof the intervertebral foramina. These models are the rat, BBB ratedsurvival assessments, the double biceps femoris, tibialis anterior andtriceps muscle fiber CSA (cross-sectional area).
Results:1.three months after operation, the survival rates of threegroups were95%,90%,90%respectively.2.The mean BBB scores were17.78±2.24,17.45±3.15,16.98±4.26.3.No limb ulcer was found in group1and group2, a rat in group3had slight plantar ulcer.
Conclusion: we confirmed the security of cutting off L2as a powersource nerve.
Part two
Objective: To evaluate the efficiency of the L2transposition toreconstruct the sacral plexus avulsion injury.
Methods: ninety adult rats with sacral plexus avulsion were dividedinto three groups at random. Group1was control group (sham group), ratsin group2were adopted L2transposition for the reconstruction theinjured contralateral sacral plexus, and rats in group3were adopted L6to reconstruct the injured contralateral sacral plexus. After surgery,the rats in each group were selected for nerve tissue morphology underthe electron microscope and microscope. The rats were evaluated with eachgroup, electron microscopy weight, BBB rating and muscle fiber CSA(cross-sectional area) of the double-biceps femoris, tibialis anteriorand triceps survival.
Results: three months after operation, the BBB scores indicatedsignificant differences between2experimental groups and the controlgroups. We found that in the double biceps femoris muscle weight and fiberCSA, tibia significant difference in the proportion of muscle and tricepssurae between2experimental groups and the control group. In the group2and group3, the biceps femoris, tibialis anterior and triceps recoveryis different. The former was better than the latter. Observation of nervetissue was under the microscope and microscopic morphology electronic.
Conclusion: the L2transposition with autograft of nerve roots canreconstruct partial function of sciatic nerve the in paraplegia rats. L2was also a effective choice when more power source nerves were needed.
Part three
Objective: to evaluate the degeneration of the target muscle aftersacral plexus avulsing injury.
Methods:60adult SD rats with sacral plexus avulsion were chosenat random. Rats were divided into6groups at random. Group1-6. Both sidesof biceps femoris, triceps surae and tibial muscle were drawn from a groupat2w,4w,6w,8w,10w, and12w after operation. Muscle wet weights, musclefiber cross section areas and myocyte diameters were measured. Thehistomorphology of the motor endplate was also observed.
Results: muscle wet weights, muscle fiber cross section areas andmyocyte diameters of the denervated muscle decreased progressively.Within4weeks, the motor endplate showed no significant change, they beganto disappear after4weeks, and after12weeks, they were hardly found.
Conclusion: muscle wet weights, muscle fiber cross section areas andmyocyte diameters of the denervated muscle decreased progressively. Themotor endplate began to disappear after4weeks.
Part four
Objective: to evaluate the law of central reconstruction of rat withL2transposition to reconstruct the sacral plexus avulsing injury.
Method:30adult SD rats were divided into three groups at random.Rats in group1were with right sacral plexus avulsion injury, in group2were adopted with L2transposition, and in group3were normal (shamgroup). Sixteen weeks after operation, without feeding for12hours,0.2ml18F-FDG was injected into rat from tail vein. Electrical stimulation wasgiven on right lower limbs. Rats would undergo pet-CT scan40minutes later,total brain and neck were contained.
Results: rats in group1showed no significant imaging in bothcerebral hemispheres, in group2showed significant imaging in bothcerebral hemispheres, and in group3showed significant imaging in leftcerebral hemisphere.
Conclusion: reconstruction of cerebral cortex is the symbol ofsuccessful nerve transposition.
第一部分腰2神经根作为动力源神经的安全性研究
目的：了解切取单根腰2神经根对一侧肢体的影响，以及术后靶细胞退变规律的研究。
方法：选取60只成年SD大鼠，雌雄不限，不打开椎管，在椎体神经孔外侧切断右侧腰4-腰6神经根，术后通过体感诱发电位来进行筛选，剔除造模不成功的大鼠，另取大鼠造模补足数量。将造模成功的大鼠分为3组，第一组为假手术对照组；第二组将大鼠的健侧腰2在椎管外切断；第三组将大鼠健侧腰2及腰6同时在椎管外切断。术后观察三组大鼠的一般情况，生存率，进行行为学观察和测试以及电生理检查。
结果：1、一般情况：术后16周，三组大鼠分别存活19只、18只、18只；2、16周时三组大鼠左侧BBB评分分别为10.92±3.14、10.69±3.29、10.38±3.77；3、第一组及第二组大鼠均未发现有健侧肢体溃疡和自噬现象，第三组有一只大鼠出现轻微的足底溃疡，后愈合。
结论：以腰2神经根作为动力源神经是安全可靠的，但是同时采用健侧的腰2及腰6神经根作为动力源神经可能会在早期有个别的出现难以代偿的失神经现象。
第二部分利用腰2修复骶丛神经撕脱伤的研究
目的：评价采用腰2作为动力源神经去修复骶丛撕脱伤的有效性。
方法：选用已成年的200-300g的SD大鼠共90只，雄雌不限，进行右侧骶丛撕脱伤造模，术后通过SEP健侧剔除造模不成功的大鼠，另取大鼠造模补足数量。将大鼠随机分为三组，分别为假手术组、健侧腰2-伤侧腰6吻合组、健侧腰6-伤侧腰6吻合组。术后观察各组大鼠的存活情况，对大鼠进行BBB评分；双侧股二头肌、小腿三头肌及胫前肌称量湿重和观察到的肌肉横断面对比和比较HE染色，电镜观察神经远端吻合口增长;利用肌电图来评估一贯作业的有效性。
结果：术后12周BBB评分显示，两吻合组得分均高于假手术组，差异有统计学意义，两吻合组之间无明显差异。吻合组患侧的胫前肌、小腿三头肌及股二头肌与不吻合组比较，有明显的恢复，差异有统计学意义。吻合组内三组肌肉尤其以股二头肌恢复为佳。
结论：健侧腰2神经根移位是能够有效的进行骶丛撕脱伤修复的动力源神经，能够解决由于无法找到神经根残端而无法修复的困难或者动力源神经不足时候的有效补充。
第三部分大鼠单侧骶丛撕脱伤后靶肌肉退变规律的研究
目的：研究单侧骶丛撕脱伤后靶肌肉的退变规律。
方法：选用体重200-300g的成年SD大鼠60只，雄雌不限，建立单侧骶丛撕脱伤模型，。分别于损伤后2周，4周，6周，8周，10周，12周取大鼠两侧的小腿三头肌，测量肌肉湿重、肌细胞直径及肌肉横截面积及观察运动终板形态。
结果：在肌肉失神经支配后，肌肉湿重、肌细胞直径及肌肉横截面积均下降，其中肌细胞直径及肌肉横截面积均呈进行性下降过程，而肌肉湿重呈现前快后慢的下降过程。在4周内，运动终板无明显变化，4周后，其边缘开始变得模糊，进而消失，12周基本很难找到。
结论：肌肉湿重、肌细胞直径及肌肉横截面积均出现下降，运动终板在4周后开始逐渐消失。
第四部分骶丛撕脱伤修复后中枢重建规律的研究
目的：研究单侧骶丛撕脱伤健侧腰2移位后中枢重建规律。
方法：选用体重200-300g的成年SD大鼠30只，雄雌不限，将其随机分为3组：第一组：右侧骶丛撕脱伤损伤不修复组，为阴性对照组，10只；第二组：健侧L2神经根移位修复组，10只；第三组：假手术组，不做特殊处理，10只。术后4个月，大鼠禁食12小时，尾静脉注射0.2ml18F-FDG，同时持续电刺激右侧患肢，吸收40分钟后上机扫描，扫描视野包括大鼠整个脑部及颈部。
结果：第一组大鼠脑部基本无明显显像，第二组大鼠脑部双侧均有显像，第三组大鼠左侧脑部显像较为明显。
结论：神经根移位成功，大脑皮层功能区的定位会发生重建。
Nowadays, people travel faster than before. So, severe trafficinjuries increase. Pelvic fracture becomes common in the clinical work.Ventral root avulsion or ventral injury arisen from pelvic fracture comessubsequently. We have no efficient methods to deal with them. For a longperiod, conservative treatment was the first choice for this kind ofinjuries. In recent years, some doctors tried surgeries. The most adoptedmethod was ventral nerves exploration. Patients could hardly getsatisfied outcome. CHEN Aimin et al. used the contralateral L1root asa power source nerve to repair sacral root avulsion, and they had primarilyconfirmed its security and validity. Then a new problem occurred, we needmore power source nerves for the repair. Lumbar plexus may be a idealchoice. After operation, We used to evaluate many aspects of theeffectiveness of this method of treatment.
Part one
Objective: to evaluate the security of cutting L2as a power sourcenerve and find out the degeneration law of the target cell.
Method: sixty adult SD rats were chosen at random to establish thesacral nerve root models by avulsing the right side of L4-L6rat nerveroots of the intervertebral foramen without laminectomy. These rats weredivided into three groups at random, group1was control group (sham group),L2nerve roots of rats in group2were cut off outside the intervertebralforamina, and L2and L6nerve roots of rats in group3were cut off outof the intervertebral foramina. These models are the rat, BBB ratedsurvival assessments, the double biceps femoris, tibialis anterior andtriceps muscle fiber CSA (cross-sectional area).
Results:1.three months after operation, the survival rates of threegroups were95%,90%,90%respectively.2.The mean BBB scores were17.78±2.24,17.45±3.15,16.98±4.26.3.No limb ulcer was found in group1and group2, a rat in group3had slight plantar ulcer.
Conclusion: we confirmed the security of cutting off L2as a powersource nerve.
Part two
Objective: To evaluate the efficiency of the L2transposition toreconstruct the sacral plexus avulsion injury.
Methods: ninety adult rats with sacral plexus avulsion were dividedinto three groups at random. Group1was control group (sham group), ratsin group2were adopted L2transposition for the reconstruction theinjured contralateral sacral plexus, and rats in group3were adopted L6to reconstruct the injured contralateral sacral plexus. After surgery,the rats in each group were selected for nerve tissue morphology underthe electron microscope and microscope. The rats were evaluated with eachgroup, electron microscopy weight, BBB rating and muscle fiber CSA(cross-sectional area) of the double-biceps femoris, tibialis anteriorand triceps survival.
Results: three months after operation, the BBB scores indicatedsignificant differences between2experimental groups and the controlgroups. We found that in the double biceps femoris muscle weight and fiberCSA, tibia significant difference in the proportion of muscle and tricepssurae between2experimental groups and the control group. In the group2and group3, the biceps femoris, tibialis anterior and triceps recoveryis different. The former was better than the latter. Observation of nervetissue was under the microscope and microscopic morphology electronic.
Conclusion: the L2transposition with autograft of nerve roots canreconstruct partial function of sciatic nerve the in paraplegia rats. L2was also a effective choice when more power source nerves were needed.
Part three
Objective: to evaluate the degeneration of the target muscle aftersacral plexus avulsing injury.
Methods:60adult SD rats with sacral plexus avulsion were chosenat random. Rats were divided into6groups at random. Group1-6. Both sidesof biceps femoris, triceps surae and tibial muscle were drawn from a groupat2w,4w,6w,8w,10w, and12w after operation. Muscle wet weights, musclefiber cross section areas and myocyte diameters were measured. Thehistomorphology of the motor endplate was also observed.
Results: muscle wet weights, muscle fiber cross section areas andmyocyte diameters of the denervated muscle decreased progressively.Within4weeks, the motor endplate showed no significant change, they beganto disappear after4weeks, and after12weeks, they were hardly found.
Conclusion: muscle wet weights, muscle fiber cross section areas andmyocyte diameters of the denervated muscle decreased progressively. Themotor endplate began to disappear after4weeks.
Part four
Objective: to evaluate the law of central reconstruction of rat withL2transposition to reconstruct the sacral plexus avulsing injury.
Method:30adult SD rats were divided into three groups at random.Rats in group1were with right sacral plexus avulsion injury, in group2were adopted with L2transposition, and in group3were normal (shamgroup). Sixteen weeks after operation, without feeding for12hours,0.2ml18F-FDG was injected into rat from tail vein. Electrical stimulation wasgiven on right lower limbs. Rats would undergo pet-CT scan40minutes later,total brain and neck were contained.
Results: rats in group1showed no significant imaging in bothcerebral hemispheres, in group2showed significant imaging in bothcerebral hemispheres, and in group3showed significant imaging in leftcerebral hemisphere.
Conclusion: reconstruction of cerebral cortex is the symbol ofsuccessful nerve transposition.
引文
1.Pohlemann T, Gnsslen A, Tscherne H. The problem of the sacrum fracture.Clinical analysis of377cases[J]Orthopade.1992Nov;21(6):400-12
2.Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J]. J Neurosurg Spine.2004,1(1):64-71.
3.Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91.
4.张志凌，杨迪，陈爱民健侧骶神经根移位修复骶丛撕脱伤的实验研究中华创伤杂志2011，27（4）：348-351.
5.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.
7. Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury.1997,28(9-10):674-678.
8. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report ofa case and review of the literature[J]. J Trauma,1975,15:532-535.
9. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the explorationof lumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
10. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
11. Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonancemyelography[J]. J Trauma.2004,56(1):182-184.
13. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction inlumbosacral plexopathy. Case report and review of the literature[J]. JNeurosurg.2005,102(1Suppl):86-91
14. Xuhua LU, Aimin CHEN, Complete Traumatic Anterior Dislocation of theLumbosacral Joint: A Case Report,Spine,2009，34（14）：488-492
15. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in apediatric patient [J].Orthopedics.2003,26(1):89-90.
16. Hare GM, Evans PJ, Mackinnon SE, Best TJ, Bain JR, Szalai JP, HunterDA.. Walking track analysis: a long-term assessment of peripheral nerverecovery. Plast Reconstr Surg,1992,89(2):251-258
19. Zhao S, Beuerman RW, Kline DG: Neurotization of motor nervesinnervating the lower extremity by utilizing the lower intercostal nerves.J Reconstr Microsurg113:39–45,1997.
20. Stoehr M: Traumatic and postoperative lesions of the lumbosacralplexus. Arch Neurol35:757–760,1978
21.顾立强，裴国献．周围神经损伤的基础与临床［M］．北京:人民军医出版社，2001:73-75．
22. Martijn JA，wim van der kamp，Ralph T，el al．Cortical excitabilityof the biceps muscle after intercostals-to-musculocutaneousnervetrafnsfer. Neurosurg,1998,42(4)：787－795.
23. Perani D,Brunelli GA,Tettamanti M,el a1．Remodelling of sensorimotormaps in paraplegia：a functional magnetic resonance imaging study aftera surgical nerve transfer．neurosci Lett,2001,303(1):62-66.
24.顾玉东，张高孟,陈德松,等．健侧颈7神经根移位术治疗臂丛根性撕脱伤[J]．中华医学杂志.1989,69：563-566．
25. Lou L．Shou T，Li Z,et a1． Transhemispheric functional reorganizationof the motor cortex induced by the peripheral contralateral nervetransfer to the injured arm[J]．Neuroscience.20O6，l38：l225-1231．222226.魏海峰,陈亮,顾玉东,健侧C7神经根移位对修复全臂丛根性撕脱伤术后运动皮层重塑的影响,2009,6(29):576-581
27.侯春林，郑宪友，陈爱民，等，大鼠脊髓圆锥损伤后膀胱逼尿肌及其神经肌肉接头形态学变化的研究，中国修复重建外科杂志，2005，5（21）：473-475
28. Hebel R,Stormberg MW(1986),Anatomy and Embryology of laboratoryRat.Biomed Verlag,Germany.182-184.
29.郭畹华神经细胞诱向(营养)因子与中枢神经的再生[A]见：姚志彬，陈以慈主编脑研究前沿[M]第l版．广州：广东科技出版社，1995．132—146．
30.李雨民，李玉抻，穆传杰肿瘤细胞死亡调控及其信号传导[J]国外医学：放射医学按医学分册，1998，22(5)：224-227.
31. Zhao S, Beuerman RW, Kline DG: Neurotization of motor nervesinnervating the lower extremity by utilizing the lower intercostal nerves.J Reconstr Microsurg113:39–45,1997.
32. Kilvington B: An investigation on the regeneration of nerves, withregard to surgical treatment of certain paralysis. Br Med J1:988,1907.
33.杨安峰，王平编著，大鼠的解剖和组织。北京，科技出版社。1985（第一版）1978-1978.
1. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatricpatient. 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. Bellabarba C，Stewa~JD，Ricci WM，et a1．Midline sagittal sacral fractures inanterior posterior eompression pelvic ring injuries．J Orthop Trauma，2003，17(1)：32—37
5. Majeed SA．Neurologic deficits in major pelvic injuries．Clin Orthop Relat Res，1992(282)：222—228
6.梁辉曾立新肖永志骨盆骨折并发骶丛神经损伤有关问题的探讨(附3例报告)齐齐哈尔医学院学报200122（2）145.
7.李连欣周东生骨盆骨折合并腰骶丛压迫性损伤的早期诊断与手术治疗中华骨科杂志201030（4）391-395
8.陈爱民李永川赵良瑜等骨盆后环不稳定伴骶丛损伤的诊断和治疗中华创伤杂志201228（6）516-519
9.顾玉东．臂丛神经根性撕脱伤的术式与原测．中华外科杂志，2004，20(2)：65-67
10.王树锋薛云浩刘佳勇闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用中华骨科杂志200929（5）387-392
11.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
12.陈爱民江曦李永川等健侧骶1为动力源神经移位修复骶丛撕脱伤病例报告及文献回顾中华创伤骨科杂志201113（11）1043-1038
13. Graupe D．An overview of the state of the art of noninvasive FES for independentambulation by thoracic level paraplegics．Neurol Res，2002，24(5)431-422
14. Kilgore KL，Peckham PH，Keith MW，et a1．An implanted upperextremityneuroprosthesis．Follow-up of five patients．J Bone Joint Surg Am，1997，79(4)：533—541
1. Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury.1997,28(9-10):674-678.
2. Denis F, Davis S, Comfort T. Sacral fractures: an important problem.Retrospective analysis of236cases[J]. Clin Orthop Relat Res.1988,227:67-81.
3. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the exploration oflumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
4. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report of a caseand review of the literature[J]. J Trauma,1975,15:532-535.
5. Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonance myelography[J].J Trauma.2004,56(1):182-184.
6. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
7. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
8. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the exploration oflumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
9. Pohlemann T, Gnsslen A, Tscherne H. The problem of the sacrum fracture.Clinical analysis of377cases[J]Orthopade.1992Nov;21(6):400-12
10. Pohlemann T, Gnsslen A, Tscherne H。The problem of the sacrum fracture.Clinical analysis of377cases[J]Orthopade.1992Nov;21(6):400-12.
11. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91.
12. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J]. J Neurosurg Spine.2004,1(1):64-71.
13.张志凌，杨迪，陈爱民健侧骶神经根移位修复骶丛撕脱伤的实验研究中华创伤杂志2011，27（4）：348-351.
14. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91
15.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.
16. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in apediatric patient [J].Orthopedics.2003,26(1):89-90.
17. Xuhua LU, Aimin CHEN, Complete Traumatic Anterior Dislocation of theLumbosacral Joint: A Case Report,Spine,2009，34（14）：488-492
18.杨延军，邱伟婷，黄刚等失神经支配骨骼肌的观察中华全科医学20119（7）：1004-05.
2.Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J]. J Neurosurg Spine.2004,1(1):64-71.
3.Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91.
4.张志凌，杨迪，陈爱民健侧骶神经根移位修复骶丛撕脱伤的实验研究中华创伤杂志2011，27（4）：348-351.
5.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.
7. Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury.1997,28(9-10):674-678.
8. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report ofa case and review of the literature[J]. J Trauma,1975,15:532-535.
9. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the explorationof lumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
10. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
11. Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonancemyelography[J]. J Trauma.2004,56(1):182-184.
13. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction inlumbosacral plexopathy. Case report and review of the literature[J]. JNeurosurg.2005,102(1Suppl):86-91
14. Xuhua LU, Aimin CHEN, Complete Traumatic Anterior Dislocation of theLumbosacral Joint: A Case Report,Spine,2009，34（14）：488-492
15. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in apediatric patient [J].Orthopedics.2003,26(1):89-90.
16. Hare GM, Evans PJ, Mackinnon SE, Best TJ, Bain JR, Szalai JP, HunterDA.. Walking track analysis: a long-term assessment of peripheral nerverecovery. Plast Reconstr Surg,1992,89(2):251-258
19. Zhao S, Beuerman RW, Kline DG: Neurotization of motor nervesinnervating the lower extremity by utilizing the lower intercostal nerves.J Reconstr Microsurg113:39–45,1997.
20. Stoehr M: Traumatic and postoperative lesions of the lumbosacralplexus. Arch Neurol35:757–760,1978
21.顾立强，裴国献．周围神经损伤的基础与临床［M］．北京:人民军医出版社，2001:73-75．
22. Martijn JA，wim van der kamp，Ralph T，el al．Cortical excitabilityof the biceps muscle after intercostals-to-musculocutaneousnervetrafnsfer. Neurosurg,1998,42(4)：787－795.
23. Perani D,Brunelli GA,Tettamanti M,el a1．Remodelling of sensorimotormaps in paraplegia：a functional magnetic resonance imaging study aftera surgical nerve transfer．neurosci Lett,2001,303(1):62-66.
24.顾玉东，张高孟,陈德松,等．健侧颈7神经根移位术治疗臂丛根性撕脱伤[J]．中华医学杂志.1989,69：563-566．
25. Lou L．Shou T，Li Z,et a1． Transhemispheric functional reorganizationof the motor cortex induced by the peripheral contralateral nervetransfer to the injured arm[J]．Neuroscience.20O6，l38：l225-1231．222226.魏海峰,陈亮,顾玉东,健侧C7神经根移位对修复全臂丛根性撕脱伤术后运动皮层重塑的影响,2009,6(29):576-581
27.侯春林，郑宪友，陈爱民，等，大鼠脊髓圆锥损伤后膀胱逼尿肌及其神经肌肉接头形态学变化的研究，中国修复重建外科杂志，2005，5（21）：473-475
28. Hebel R,Stormberg MW(1986),Anatomy and Embryology of laboratoryRat.Biomed Verlag,Germany.182-184.
29.郭畹华神经细胞诱向(营养)因子与中枢神经的再生[A]见：姚志彬，陈以慈主编脑研究前沿[M]第l版．广州：广东科技出版社，1995．132—146．
30.李雨民，李玉抻，穆传杰肿瘤细胞死亡调控及其信号传导[J]国外医学：放射医学按医学分册，1998，22(5)：224-227.
31. Zhao S, Beuerman RW, Kline DG: Neurotization of motor nervesinnervating the lower extremity by utilizing the lower intercostal nerves.J Reconstr Microsurg113:39–45,1997.
32. Kilvington B: An investigation on the regeneration of nerves, withregard to surgical treatment of certain paralysis. Br Med J1:988,1907.
33.杨安峰，王平编著，大鼠的解剖和组织。北京，科技出版社。1985（第一版）1978-1978.
1. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in a pediatricpatient. 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. Bellabarba C，Stewa~JD，Ricci WM，et a1．Midline sagittal sacral fractures inanterior posterior eompression pelvic ring injuries．J Orthop Trauma，2003，17(1)：32—37
5. Majeed SA．Neurologic deficits in major pelvic injuries．Clin Orthop Relat Res，1992(282)：222—228
6.梁辉曾立新肖永志骨盆骨折并发骶丛神经损伤有关问题的探讨(附3例报告)齐齐哈尔医学院学报200122（2）145.
7.李连欣周东生骨盆骨折合并腰骶丛压迫性损伤的早期诊断与手术治疗中华骨科杂志201030（4）391-395
8.陈爱民李永川赵良瑜等骨盆后环不稳定伴骶丛损伤的诊断和治疗中华创伤杂志201228（6）516-519
9.顾玉东．臂丛神经根性撕脱伤的术式与原测．中华外科杂志，2004，20(2)：65-67
10.王树锋薛云浩刘佳勇闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用中华骨科杂志200929（5）387-392
11.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
12.陈爱民江曦李永川等健侧骶1为动力源神经移位修复骶丛撕脱伤病例报告及文献回顾中华创伤骨科杂志201113（11）1043-1038
13. Graupe D．An overview of the state of the art of noninvasive FES for independentambulation by thoracic level paraplegics．Neurol Res，2002，24(5)431-422
14. Kilgore KL，Peckham PH，Keith MW，et a1．An implanted upperextremityneuroprosthesis．Follow-up of five patients．J Bone Joint Surg Am，1997，79(4)：533—541
1. Chin CH, Chew KC. Lumbosacral nerve root avulsion[J]. Injury.1997,28(9-10):674-678.
2. Denis F, Davis S, Comfort T. Sacral fractures: an important problem.Retrospective analysis of236cases[J]. Clin Orthop Relat Res.1988,227:67-81.
3. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the exploration oflumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
4. Barnett HG, Connolly ES: Lumbosacral nerve root avulsion: report of a caseand review of the literature[J]. J Trauma,1975,15:532-535.
5. Monga P, Ahmed A, Gupta GR, et al. Traumatic lumbar nerve root avulsion:evaluation using electrodiagnostic studies and magnetic resonance myelography[J].J Trauma.2004,56(1):182-184.
6. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
7. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. Apostmortem radiographic and patho-anatomical study[J]. Acta Chir Scand.1972,429Suppl:3-43.
8. Maillard JC, Zouaoui A, Bencherif B, et al.Imaging in the exploration oflumbosacral plexus avulsion[J]. J Neuroradiol1992,19:38.
9. Pohlemann T, Gnsslen A, Tscherne H. The problem of the sacrum fracture.Clinical analysis of377cases[J]Orthopade.1992Nov;21(6):400-12
10. Pohlemann T, Gnsslen A, Tscherne H。The problem of the sacrum fracture.Clinical analysis of377cases[J]Orthopade.1992Nov;21(6):400-12.
11. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91.
12. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexusinjuries[J]. J Neurosurg Spine.2004,1(1):64-71.
13.张志凌，杨迪，陈爱民健侧骶神经根移位修复骶丛撕脱伤的实验研究中华创伤杂志2011，27（4）：348-351.
14. Tung TH, Martin DZ, Novak CB, et al. Nerve reconstruction in lumbosacralplexopathy. Case report and review of the literature[J]. J Neurosurg.2005,102(1Suppl):86-91
15.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.
16. Shaw BA, Holman M. Traumatic lumbosacral nerve root avulsions in apediatric patient [J].Orthopedics.2003,26(1):89-90.
17. Xuhua LU, Aimin CHEN, Complete Traumatic Anterior Dislocation of theLumbosacral Joint: A Case Report,Spine,2009，34（14）：488-492
18.杨延军，邱伟婷，黄刚等失神经支配骨骼肌的观察中华全科医学20119（7）：1004-05.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |