Efficacy of autologous peripheral blood mononuclear cells in treatment of high radial nerve injury

doi:10.3969/j.issn.2095-4344.0457

Abstract

Abstract:

BACKGROUND: In recent years, neural stem cells, adipose tissue derived mesenchymal stem cells, muscle derived stem cells and induced pluripotent stem cells have been applied in the treatment of peripheral nerve injuries. However, the treatment of peripheral nerve injury by autologous peripheral blood mononuclear cells has rarely been reported.
OBJECTIVE: To investigate the efficacy of autologous peripheral blood mononuclear cells in the treatment of high radial nerve injury.
METHODS: From April 2011 to September 2015, 12 cases of radial nerve injury in the middle arm were treated. Preoperatively peripheral blood mononuclear cells were mobilized, and then 15 mL of mononuclear cell suspension was prepared on the operation day. Radial nerves scheduled for anastomosis were surgically explored and subjected to end-end anastomosis using outer membrane suturing under microscope. The anastomotic site of the nerve was enveloped with gelatin sponge soaked with 5 mL of autologous peripheral blood mononuclear cell suspension. The remaining 10mL of cell suspension was used for a multi-point injection into the local muscles, 0.5 mL at each point. Thereafter, the deep fascia and the incision were sutured in sequence. Postoperative antibiotics were used to prevent infection for 48 hours, and upper limb immobilization lasted for 4 weeks. Performance of rehabilitation exercise was guided. During the follow-up, wrist dorsal extension and muscle strength of extensor carpi ulnaris and extensor digitorum communis were detected to evaluate the therapeutic efficacy.
RESULTS AND CONCLUSION: All the patients were followed up for 15 to 36 months, with an average of 17 months. Efficacy was excellent in 9 cases, good in 2 cases, fair in 1 case and poor in 0 case. The excellent and good rate was 92%. The wrist dorsal extension could achieve the functional needs, and the thumb dorsal extension and finger extension basically met the functional requirements. It is suggested that autologous peripheral blood mononuclear cell transplantation can achieve good outcomes in the treatment of high radial nerve injury.

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

Key words: Radial Nerve, Peripheral Blood Stem Cell Transplantation, Nerve Regeneration, Tissue Engineering

CLC Number:

R394.2

Yue Feng-wen, Liu Li-ping, Sun Guang-feng, Wu Xiang-kui, Wei Zai-rong, Wang Da-li. Efficacy of autologous peripheral blood mononuclear cells in treatment of high radial nerve injury[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(9): 1438-1442.

Figures/Tables 1

2.1 受试者数量分析入组患者12例，男7例，女5例，术后均获随访，随访期无脱落。 2.2 研究对象入组流程见图1。 2.3 腕关节背伸及伸拇伸指情况共计12例患者，术后均获随访，随访时间15-36个月，平均17个月。腕关节背伸 > 45° 10例、 ≥ 30° 2例、< 30° 0例；掌指关节背伸优9例、良2例、可1例、差0例；拇指背伸优8例、良3例、可1例、差0例；桡侧外展恢复满意。综合评价：优9例，良2例，可1例，差0例，优良率为92%。 2.4 不良反应术后伤口均Ⅰ期愈合，无感染、血肿并发症发生，外周血单个核细胞动员过程中未见与重组人粒细胞刺激因子相关不良反应，无血栓及心脑血管事件发生；提取过程中2例患者发生低钙抽搐不适，给予静脉缓慢注射10%葡萄糖酸钙10 mL后缓解；移植后患者均未发生发热、过敏、免疫排斥反应。 2.5 典型病例患者男，16岁，因刀刺伤左上臂致垂腕垂指畸形伴功能障碍4 d入院。入院查体：生命体征平稳。专科情况：左上臂敷料包扎中，无渗血、渗液，打开敷料见左前臂稍肿胀，中段外侧一长约5 cm纵行切口已清创缝合，左侧腕关节下垂，腕关节背伸不能，虎口区痛觉消失，手指背伸不能，左手拇指背伸不能，桡侧外展不能，左侧肩关节活动正常，肘关节伸曲正常，桡动脉搏动正常，肢端血运好。诊断：左上臂桡神经损伤。完善术前相关检查，入院白细胞7.27×109 L-1，重组人粒细胞刺激因子10 μg/(kg•d)皮下注射，每日监测血常规，动员2 d后白细胞升至26.51×109 L-1 ，开始采集外周血单个核细胞。臂丛麻醉下行桡神经探查吻合术+自体外周血单个核细胞局部移植术，石膏外固定上肢肘关节于90°屈曲位、伸腕20°-30°、掌指关节伸直位，常规给予抗生素预防感染48 h，2周拆线，石膏外固定4周，改用手功能肢具夜间给予保护，并指导患者康复锻炼。随访观察18个月，腕关节背伸有力，腕关节背伸45°，伸指、伸拇满意，见图2。"

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