中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (2): 249-252.doi: 10.3969/j.issn.1673-8225.2010.02.014

• 组织构建与生物活性因子 tissue construction and bioactive factors • 上一篇    下一篇

周围神经联合生长因子移植治疗急性脊髓损伤

侯占江1，杨  硕1，孟祥林2，夏昊晨1，樊昌东1，闫景龙3   

  1. 哈尔滨医科大学附属第一医院，  1急诊创伤外科，  3骨四科，黑龙江省哈尔滨市150001；2黑龙江省海伦市第二人民医院骨科，黑龙江省海伦市 152300
  • 出版日期:2010-01-08 发布日期:2010-01-08
  • 作者简介:侯占江★，男，1971年生，黑龙江省哈尔滨市人，汉族，1995年哈尔滨医科大学毕业，硕士，主治医师, 主要从事周围神经损伤修复、促周围神经再生研究。 xinxin9129@126.com

Peripheral nerve transplantation with growth factors for acute spinal cord injury

Hou Zhan-jiang1, Yang Shuo1, Meng Xiang-lin2, Xia Hao-chen1, Fan Chang-dong1, Yan Jing-long3   

  1. 1 Department of Emergent Trauma Surgery, 3 The Fourth Department of Orthopedics, First Affiliated Hospital of Harbin Medical University, Harbin   150001, Heilongjiang Province, China;2 Department of Orthopedic, Second People's Hospital of Hailun, Hailun   152300, Heilongjiang Province, China
  • Online:2010-01-08 Published:2010-01-08
  • About author:Hou Zhan-jiang★, Master, Attending physician, Department of Emergent Trauma Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China xinxin9129@126.com

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360

被引次数

3

摘要：

背景：目前促进神经再生与修复的策略也主要是通过促进神经内在的再生能力和改善再生的微环境两大途径，已有的研究表明联合应用一些治疗手段能更好地促进神经轴突的再生生长。
目的：探讨周围神经联合生长因子移植治疗大鼠脊髓损伤的可行性及效果。
方法：健康成年雌性SD大鼠60只，随机数字表法分为4组：神经移植组、神经移植联合生长因子组、脊髓横断组、椎板切除组。以T9为中心纵行切开大鼠皮肤，显露硬膜囊，水平切断脊髓并切除3mm，神经移植组、神经移植联合生长因子组取双侧第8~10对肋间神经各2 cm，将自体肋间神经修剪成合适长度后交叉移植入脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质)，神经移植组用纤维蛋白凝胶固定植入的肋间神经，神经移植联合生长因子组用含有2.1 mg/L 酸性成纤维细胞生长因子的纤维蛋白凝胶固定植入的肋间神经，缝合硬膜。脊髓横断组断端间旷置，椎板切除组仅行椎板切除术。术后90 d进行体感及运动诱发电位检测，术后70 d进行Basso.Beattie.Bresnahan(BBB)后肢运动功能评分。
结果与结论：椎板切除组均引出了体感及运动诱发电位；脊髓横断组未引出体感及运动诱发电位波形；神经移植组3只引出双侧体感诱发电位，4只引出单侧体感诱发电位，4只引出双侧运动诱发电位，3只引出单侧运动诱发电位，神经移植联合生长因子组5只引出双侧体感诱发电位，2只引出单侧体感诱发电位，神经移植联合生长因子组5只引出双侧运动诱发电位，2只引出单侧运动诱发电位。神经移植组、神经移植联合生长因子组大鼠体感及运动诱发电位潜伏期及波幅明显优于脊髓横断组(P < 0.01)，自体肋神经移植联合生长因子组优于神经移植组(P < 0.01)。椎板切除组大鼠麻醉清醒后运动恢复正常, 脊髓横断组在3个月的生存期内后肢持续伸展、旋转，神经移植组和神经移植联合生长因子组大鼠后肢功能术后3周开始明显恢复，并在整个观察期内逐渐恢复。神经移植组和神经移植联合生长因子组BBB后肢运动功能评分较脊髓横断组明显提高(P < 0.01)，并且神经移植联合生长因子组较神经移植组高(P < 0.01)。提示单纯周围神经移植能部分恢复脊髓功能,联合生长因子则能更好地恢复脊髓功能。

关键词: 脊髓损伤, 周围神经, 移植

Abstract:

BACKGROUND: At present the strategy of nerve regeneration and repairing are main promoting nerve intrinsic regeneration capacity and improving the micro-environment. Studies have shown a number of combined treatment which could promote the regeneration and growth of nerve axon.
OBJECTIVE: To explore the feasibility and effect of rat spinal cord injury repaired by peripheral nerve combined growth factor.
METHODS: Sixty healthy adult female SD rats were randomly divided into 4 groups: nerve graft group, nerve graft combined growth factor group, spinal cord transaction group and laminectomy group. Taking T9 as the center, a longitudinal incision was conducted in rat skin, revealing dural sac, spinal cord was transected and removed 3 mm, 2-cm segment of the eighth to tenth intercostal nerve was obtained from nerve graft group and nerve graft combined with growth factor group, autologous intercostal nerve was cross-transplanted into spinal defect (proximal white matter and distal gray matter, distal white matter and proximal gray matter) after pruning appropriately. The transplanted intercostal nerves were fixed with fibrin glue in nerve graft group, while those in nerve graft combined growth factor group were fixed with fibrin glue containing 2.1 mg/L acidic fibroblast growth factor, followed by dural suture. Stump of broken ends was done in spinal cord transection group, while laminectomy was performed in laminectomy group.
RESULTS AND CONCLUSION: At 90 days post-surgery, somatosensory evoked potential (SEP) and motor evoked potential (MEP) were determined, the motor function of hind limbs was evaluated by the Basso. Beattie.Bresnahan (BBB) test at 70 days. Both SEP and MEP were led in the laminectomy group, but not lead in spinal cord transection group; in nerve graft group, 3 rats showed bilateral SEP, 4 led unilateral SEP, 4 led bilateral MEP, 3 led unilateral MEP; in nerve graft combined with growth factor group, 5 led bilateral SEP and 2 led unilateral SEP, 5 led bilateral MEP and 2 led unilateral MEP. The SEP and MEP latency and amplitude in the nerve graft group and nerve graft combined growth factor group were significantly superior to the spinal cord transection group (P < 0.01), autologous rib nerve graft group was better than nerve graft combined growth factor group (P < 0.01). In the laminectomy group, awake rats following anesthesia returned to normal exercise, rats in spinal cord transection group continued to extend limbs and rotated within 3 months, rats in other two groups recovered functions obviously 3 weeks post-surgery and gradually restored throughout the entire observation period. Nerve graft group and nerve graft combined growth factor group showed significantly increased BBB score compared with spinal cord transection were (P < 0.01), and the nerve graft combined growth factor group was superior to nerve graft group (P < 0.01). The peripheral nerve graft can promote the spinal function following spinal cord injury, while the nerve combined growth factor can better restore the function.

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