确认腰骶神经改道手术的有效性.pptVIP

* Neurofilament triplet protein stains the axons.三元神精丝蛋白染色轴突 * S100 protein is a Schwann cell marker.S100蛋白质是一种膜细胞生成者 The nerve trunks and twigs are stained stronger than the background collagen. 神经细胞中继线及细支比背景的胶原蛋白染色更深 * Red star.红星- Collagen 胶原蛋白(fibrosis纤维化) – yellow green birefringence 黄绿双折射. Light blue arrows.浅蓝色箭头- Suture material 缝合材料(birefringent折射) Determining the Effectiveness of an Intradural Lumbo-Sacral Nerve Rerouting Procedure确认腰骶神经改道程序的有效性 Neurosurgery神经外科: Gerald Tuite, Luis Rodriguez, Carolyn Carey, Bruce Storrs Urology泌尿学: Yves Homsy, Ethan Polsky, Mike Reisman, Mark Kolligan Physical Therapy 物理治疗: Maggie Reilly, Kathleen Thompson Neurology 神经病学: Parrish Winesett Research Nurse Coordinator 研究护理协调员: Lisa Tetreault Pathology 病理学: Ignacio Gonzalez All Children’s Hospital and Johns Hopkins Medicine St. Petersburg, FL 全儿童医院及约翰霍普金斯医学 佛罗里达州，圣匹兹堡 Two Efficacy Studies for Patients with Neurogenic Bladder对于神经性膀胱功能障碍患者的两组研究 Patients who do not have spina bifida 没有脊柱裂的患者 Spinal cord injury 脊髓损伤(exclude conus/cauda equina排除马尾和圆锥神经) Prospective 可预期的 Longitudinal 纵向的 Patients with spina bifida 有脊柱裂的患者 Only patients who require detethering （仅限要求实施去栓手术的患者） Randomized at the time of surgery （随机的手术时间） Double blinded （双盲） Clinical Trial Initiation, March 2009 2009年3月开始临床实验 Left L5 ventral root to Sacral root anastomosis 左侧L5 脊神经前根至骶神经根接合 One Spinal Cord Injury Patient一名脊髓损伤患者 Primary End Points 首要终点 Voiding 排尿 Scratch Test described by Xiao et al 由肖等人描述的抓挠试验 Continence 自制 Secondary end points 次要终点 Motor and sensory function 运动和感觉功能 Bowel function 肠功能 Urodynamic changes 尿流动力学变化 Sexual function 性功能 Quality of life 生活质量 Ability to perform ADL日常活动能力 Frequency and severity of surgical complications 手术并发症的频率与程度 Assessment at 3,6,12,18 and 24 months在3,6,12,18 和24个月的评测 Six Months – initial optimism 六个月-初始乐观 Some improvement in bladder and bowel function 膀胱和肠功能的部分改善 Possible initiation of voiding? 可能启动排尿？ Urologists saw bladder contractions on urodynamic te