马尾神经根横断后修复方法的实验观察

目的 探讨治疗马尾神经离断的更有效方法。方法 作者用缝合法，纤维素胶法修复猫椎管一侧横断的腰６，腰７神经根，并以对侧自然连续做为对照，对神经轴突行免疫组化特异染色，图像分析，结果 马尾神经损务后不但在吻合口前后有明显的轴突再生，在相应的脊髓和神经节内的神经元均有明显的再生表现；神经根横断前后及取标本前的诱发电位变化提示神经根损伤与再生的功能变化过程；在再生的过程运动根的优于感觉根的再生，感觉根的再     

带不带血管周围神经移植的比较

比较带与不带血管周围神经移植的再生情况扩探讨其再生柚是。用ＳＤ雄性大鼠５０只，机分组，６只为正常对照组，其余等分为Ａ组和Ｂ组。两组均在移植后不同时间取材，其余等分为Ａ组和Ｂ组。两组均在移植后不同时间取材，进行不镜，电镜对比观察。     

甘油保存鼠坐骨神经异体移植诱导神经再生的研究

为制备既无明显抗原性.又具备完整神经内膜管结构,且便于长期保存的神经移植物.我们用甘油保存鼠坐骨神经异体移植.诱导神经再生.现将实验结果报道如下.     

优化法去细胞大鼠神经同种异体移植修复坐骨神经缺损

[目的]以优化法去细胞大鼠神经移植,修复同种异体坐骨神经缺损,观察术后动物的免疫排斥、早期功能恢复及神经再生情况。[方法]以优化去细胞方法处理新鲜取材的成年SD大鼠坐骨神经,移植修复同种异体1.0cm坐骨神经缺损,以自体神经和新鲜异体神经移植为对照,术后1个月行坐骨神经功能指数评价、神经电生理和组织学检查,观察动物在功能恢复、免疫排斥及神经再生方面的情况。[结果]自体神经和去细胞异体神经移植组动物的坐骨神经功能指数无显著差异(P>0.05),大体观察均可见神经连续性良好。电生理检测表明2组动物移植神经均已恢复电传导能力,在传导速度(CV)上无显著差异(P>0.05),但均未达到正常神经水平(P<0.05)。组织学观察则显示2组再生神经纤维均已长入移植段远端。S-100免疫组化显示两者在雪旺氏细胞数、形态和排列等方面无明显差异。2组在CD8 T细胞和巨噬细胞免疫组化染色阳性面积百分比上差异无统计学意义(P>0.05)。计算移植神经中段轴突密度后表明两者无显著差异(P>0.05),但都比正常神经小(P<0.05),比新鲜异体神经移植组大(P<0.05)。[结论]优化去细胞神经移植组与自体神经移植组在免疫排斥、功能恢复及神经再生方面无显著差异。优化法去细胞神经在移植修复同种异体神经缺损时,可以达到免疫耐受,其早期功能恢复和神经再生情况良好,在修复周围神经缺损时可以作为自体神经移植的一种替代疗法。     

优化法去细胞兔神经移植修复大鼠坐骨神经缺损

目的 以优化法去细胞兔臂丛神经，移植修复大鼠坐骨神经缺损，观察免疫排斥情况、早期功能恢复及神经再生情况。方法 以优化法处理新鲜取材的新西兰大白兔臂丛神经分支，移植修复成年sD大鼠坐骨神经1．0cm缺损，分别于术后1个月及3个月行功能评价、电生理和组织学检查，观察免疫排斥、功能恢复及神经再生情况。结果 实验组与自体神经移植组在免疫排斥、功能恢复及神经再生方面无显著差异，却明显优于新鲜兔神经移植组。3个月取材时的神经再生及功能恢复情况优于1个月取材时。结论 优化法去细胞神经在移植修复异种神经缺损时，可以达到免疫耐受，其早期功能恢复和神经再生情况良好，在修复周围神经缺损时有望作为自体神经移植的一种替代疗法。     

带与不带血管周围神经移植的比较

目的：比较带与不带血管周围神经移植的再生情况及探讨其再生机理。方法：用ＳＤ雄性大鼠５０只，随机分组，６只为正常对照组，其余等分为Ａ组（带血管神经移植组）和Ｂ组（不带血管神经移植组）。两组均在移植后不同时间取材，进行光镜、电镜对比观察。结果：在移植后的前４周，Ａ、Ｂ两组组织形态学变化基本相似。从第６周开始，移植段神经纤维再生率、有髓神经纤维再生率、有髓神经纤维直径恢复率、神经纤维变性率，Ａ组均明显优于Ｂ组，并进行了差异程度比较。Ａ组结缔组织增生少，神经纤维再生好。发现Ｂ组神经束内有结缔组织包裹２～３条神经纤维呈小束，再生而又变性的神经纤维多。结论：带血管周围神经移植优于不带血管的周围神经移植。     

犬化学去细胞神经同种异体移植的早期观察

目的：以化学去细胞同种异体神经，移植修复犬粗大神经的长段缺损，观察早期功能恢复及神经再生。方法：去细胞神经移植组和自体神经移植组各3犬，分别桥接坐骨神经5.0cm缺损。术后3个月观察其运动功能及神经再生。结果：实验组和对照组在术后功能恢复；移植段内新生神经纤维、新生血管及许旺细胞；吻合口远端有髓神经纤维等方面非常相似。结论：化学去细胞神经作为同种异体神经移植物，在修复粗大和长段神经缺损时不会被宿主排斥和吸收，其早期功能恢复及神经再生与自体神经移植无明显差别。     

雪旺细胞移植与周围神经再生

广泛阅读近年来有关人工神经方面的文献，重点了解桥接神经的移植体和雪旺细胞移植方面的研究进展。自体材料，异体材料和合成材料均可作为桥接神经缺损的神经导管，以化学萃取的同种异体神经较为理想，雪旺细胞体外纯化和培养后仍具有生物活性，用微注入法把雪旺细胞植入移植物内可促进神经轴突的再生。理想的人工神经应由有特定的三维结构的生物材料和有生物活性的雪旺细胞构成，雪旺细胞在支架内有序的分布，类似于Bungner带。     

周围神经移植修复大鼠陈旧性脊髓损伤的实验研究

目的：探讨利用自体周围神经组织游离移植修复大鼠陈旧性脊髓损伤病理机制。方法：利用改良Allen撞击方法建立脊髓打击损伤模型后，将大鼠分为2组，各20只。神经移植组切取后肢腓肠神经，利用显微外科技术去除神经外膜，将其修剪成小段，游离移植于脊髓损伤处，对照组不作处理。分别于术后4、12周，在光镜下观察脊髓损伤段及移植周围神经再生情况，并应用辣根过氧化物酶神经逆行示踪技术进行脊髓神经束的再生评价。分3个时点（1、2、3个月）观察大鼠后肢运动功能恢复情况。结果：对照组脊髓变性，可见瘢痕和空洞，移植组术后12周，损伤区脊髓与周围神经融合良好，可见再生轴突，跨越损伤段脊髓，周围神经无变性。12周时脊髓神经束的再生评价结果提示：神经移植组优于对照组．移植组大鼠后肢运动功能明显恢复。结论：周围神经组织游离移植修复大鼠陈旧性脊髓损伤后，存活良好并可促进大鼠脊髓结构和功能的恢复。     

Electrodiagnosis of compression of individual nerve roots of the cauda equina

Summary Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylosis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervertebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement.In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.

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Résumé L'électrodiagnostic segmentaire de la compression des racines de la queue de cheval a été tenté chez 45 malades, comprenant des cas de hernie discale, de spondylarthrite et de spondylolisthésis. L'électrode est insérée dans la racine soit en dehors du trou de conjugaison, soit à travers le canal sacré postérieur. Les enregistrements consécutifs à la stimulation d'une seule racine sont le potentiel évoqué somatosensoriel, le potentiel d'action de la queue de cheval et les ondes M et H. Des potentiels d'action mixtes des racines nerveuses de la moelle sont également enregistrés en stimulant les nerfs sciatique, sciatique poplité externe et interne. On en déduit qu'un diagnostic est possible à partir du potentiel évoqué somatosensoriel de l'onde H et de la reproduction de douleur radiculaire et qu'ainsi peut être reconnue une compression infra-clinique.Autrement dit, l'état neurophysiologique du dysfonctionnement de chacune des racines dans chaque aspect d'une compression peut être exprimeé.

     

腰椎间盘突出症并马尾神经损伤的手术疗效观察

由椎间盘退变所致的腰椎间盘突出症、腰椎管狭窄症、腰椎间盘突出伴椎管狭窄症在临床上多引起腰及下肢的疼痛麻木,感觉及运动障碍,随着病变自行发展或在外因作用下使马尾神经受到严重压迫并损伤后则会出现马尾神经综合征（cauda equine syndrome,CES）的表现,导致不同程度膀胱和肛门括约肌功能障碍,下肢感觉、运动障碍及马鞍区感觉的丧失,部分男性患者会出现性功能障碍。此类患者在临床上并非罕见,如何最大程度地帮助患者改善马尾神经功能是治疗此类疾病的关键。     

腰骶神经损害致马尾神经综合征的临床分期及早期诊断

目的: 探讨马尾神经综合征临床发病特点, 分析其分期。方法: 分析马尾神经综合征患者的临床表现、实验室检查和影像学检查的变化规律。结果: 马尾神经综合征的临床主要表现为鞍区感觉、大小便、性功能障碍,首发症状为感觉功能的障碍, 继而出现括约肌功能及性功能的障碍。临床表现出现前BCR (bulbo cavernosus reflex)、ICR (ischio cavernosus reflex) 等已有明显异常。影像学研究认为, 大部分表现为多节段椎管狭窄。结论: 马尾神经综合征分前期、早期、中期、晚期。电生理改变和鞍区感觉的功能改变是早期诊断的指标。在前期、早期诊断马尾神经综合征称为早期诊断。     

手术治疗腰椎间盘突出症合并马尾神经损伤

腰椎间盘突出症伴马尾神经损伤如果不能得到及时诊断和治疗,其病变发展的后果是十分严重的,常常导致大小便及性功能障碍,给患者带来终身的痛苦。本院自1997年6月至2007年10月手术治疗的腰椎间盘突出症224例中,合并马尾神经损伤49例,占21．8％,根据本组随访疗效提出分析讨论如下。     

Unusual myelographic pattern in a case with redundant roots of the cauda equina

An unusual myelographic pattern of the redundant nerve roots of the cauda equina is reported. The typical serpentine filling defect of the contrast material moved along the caudocranial axis of the meningeal sac according to the position of the patient. Such a myelographic feature might be diagnostic of this rare condition.     

Implantation of cauda equina nerve roots through a biodegradable scaffold at the conus medullaris in rat

Background contextTraumatic injuries occurring at the conus medullaris of the spinal cord cause permanent damage both to the central nervous system and to the cauda equina nerve roots.PurposeThis proof-of-concept study was to determine whether implanting the nerve roots into a biodegradable scaffold would improve regeneration after injury.MethodsAll experimental works involving rats were performed according to the approved guidelines by the Mayo Clinic Institutional Animal Care and Use Committee. Surgical procedures were performed on 32 Sprague-Dawley rats. Four ventral cauda equina nerve roots were reimplanted either directly into the ventral cord stump or through a poly(lactic-co-glycolic acid) (PLGA) scaffold. These experimental groups were compared with a control group in which the nerves were inserted into a muscle fascia barrier that was placed between the spinal cord and the nerve roots. Animals were sacrificed at 4 weeks.ResultsThere was no difference in motor neuron counts in the spinal cord rostral to the injury in all treatment groups, implying equal potential for the regeneration into implanted nerve roots. One-way analysis of variance testing, with Tukey post hoc test, showed a statistically significant improvement in axon regeneration through the injury in the PLGA scaffold treatment group compared with the control (p<.05, scaffold n=11, control n=11).ConclusionsThis pilot study demonstrated that a PLGA scaffold improved regeneration of axons into peripheral nerve roots. However, the number of regenerating axons observed was limited and did not lead to functional recovery. Future experiments will employ a different scaffold material and possible growth factors or enzymes to increase axon populations.     

Nutritional supply to the cauda equina in lumbar adhesive arachnoiditis in rats

Laminectomy-induced cauda equina adhesion has been proved by rat experiments and postoperative serial MRI in humans. A degenerative change of the cauda equina has been proved when cauda equina adhesion has been prolonged. Since it has not been reported how the nutritional supply is changed in such a condition, we evaluated the glucose supply to the adhered cauda equina in rats. Wistar rats were divided into the following three groups: the control group which received no operation, the laminectomy group which underwent L5-L6 laminectomy only, and the koalin group which received 5 mg of kaolin on the dorsal extradural space following L5-L6 laminectomy. Based on ³H-methyl-glucose uptake study, we analyzed (1) glucose transport from the intraneural vessels to the nerve tissue, and (2) glucose transport from the cerebrospinal fluid to the nerve tissue. We evaluated the relation between the severity of cauda equina adhesion and ³H uptake into the cauda equina. Cauda equina adhesion was observed in 2 of 12 rats in the control group, in 3 of 12 rats in the laminectomy group, and in 18 of 20 rats in the kaolin group. In the ³H-methyl-glucose uptake study, at 12 weeks the glucose transport to the cauda equina from the vessels increased by 44%, and that from the cerebrospinal fluid decreased by 64% in the kaolin group compared with thecontrol group. In the condition of complete cauda equina adhesion, the glucose transport to the cauda equina from the vessels increased by 53% and that from the cerebrospinal fluid remarkably decreased by 72% compared with the normal cauda equina. Considering the greater nutritional importance of the cerebrospinal fluid in the cauda equina, it is most likely that the impairment of nutritional supply to adhered cauda equina may lead to eventual neural degeneration. Received: 8 September 1998 Revised: 28 December 1998 Accepted: 10 February 1999     

脊髓,圆锥与马尾损伤分类：附106例胸腰段脊柱与脊髓损伤分析

本文将１０６例胸１０到腰４的脊柱脊髓损伤的病例进行神经损伤的分类：Ｉ型：完全性脊髓损伤；Ⅱ型：完全性脊髓－圆锥损伤；Ⅲ型：不完全性圆锥马尾损伤；Ⅳ型：完全性圆锥损伤，合并部分马尾损伤：Ⅴ型：完全性圆锥马尾损伤；Ⅵ型：单纯圆锥损伤；Ⅶ型：部分马尾损伤．文章论述了每一型损伤的诊断标准，讨论了分类的意义，神经损伤与膀眈功能分级的关系；提出了以感觉、运动及膀胱功能为指标的截瘫量化功能评价的格式．     

The use of coaxially aligned freeze-thawed skeletal muscle autografts in the repair of the cauda equina — in the sheep

Summary The aim was to develop a model for study of nerve regeneration in nerve roots above the level of the dorsal root ganglion and to investigate the use of freeze-thawed muscle autografts for repair of nerve roots at this level.Four adult sheep were used for the experiment. A laminectomy was performed at the lumbosacral junction and the S2 root identified. Both the dorsal and ventral S2 roots were divided unilaterally within the dura and a freeze-thawed muscle graft was inserted into the nerve gap.When assessed at 6 months an action potential was recordable from the ventral root in one sheep. Histological examination of the nerve roots showed evidence of regeneration across the graft in the ventral roots of all the sheep and the dorsal roots of some.This preliminary work indicates a capacity for regeneration of the cauda equina and that freeze-thawed muscle can support this. It provides a useful model for further study of nerve root repair.