周围神经缺损的修复

我们于１９８９年～１９９５年收治周围神经缺损１４例，效果较满意。报告如下。１临床资料１．１一般资料本组１４例，男１１例，女３例。年龄１８～５０岁。切割伤６例，挫压伤５例，撕裂伤２例，火器伤１例。臂丛神经内侧束１例，正中神经４例，桡神经３例，尺神经２例...     

脱细胞异体神经移植在周围神经缺损修复中的应用研究进展

目的介绍脱细胞异体神经移植在周围神经缺损修复中的应用研究进展。方法广泛查阅国内外相关文献,进行回顾,综合分析脱细胞方法的进展及脱细胞处理后的异体神经移植效果。结果相对于物理方法,化学脱细胞方法可有效降低移植神经的免疫原性,经过脱细胞处理后的异体神经移植后,效果良好。结论目前随着脱细胞异体神经移植长度的增加,神经再生效果逐渐降低,宿主雪旺细胞可能存在迁移极限,对长段脱细胞异体神经再细胞化或使用辅助手段提高雪旺细胞迁移能力,可望解决这一问题。     

胎兔周围神经同种异体移植修复神经缺损的研究

为评估胎兔神经同种异体移植修复神经缺损的效果。自体神经移植作为比较、桥接长度分别为缺损神经直径的４倍、８倍和１２倍。术后１、２及３个月神经传导速度，单位面积髓鞘数，平均灰度值和面积密度值实验组与对照组显著性差异。结果表明，胎兔神经异体移植与自体神经移植效果相似。     

周围神经延长修复神经短缺的研究进展

周围神经短缺的修复方法较多，神经延长是近年来神经修复的研究热点之一。本文复习了牵拉力对神经影响的研究，并对目前神经延长方法，如神经扩张延长、直接拉拢缝接及神经球瘤缝接的研究进展进行了详细综述。     

各种导管在周围神经缺损修复中的应用

目前大量研究表明较短的神经缺损用生物导管（自体静脉等）桥接，通过趋向吸引使神经的运动和感觉轴索有选择性对接，可获得良好结果。而对于长于１ｃｍ的神经缺损，生物导管还存在很多问题。     

神经延长修复周围神经长段缺损

周围神经长段缺损临床处理比较棘手 ,疗效常不令人满意。我院自 1 983年 1月～ 1 988年 1月采用简易神经延长的方法修复周围神经长段缺损 1 2例 ,取得了较好的疗效 ,报告如下。1　临床资料1 .1　一般资料本组 1 2例 ,其中男 9例 ,女 3例。年龄 1 5～ 54岁。切割伤 2例 ,钝器伤     

周围神经缺损的修复

周围神经缺损的修复解放军总医院（１００８５３）朱盛修四肢创伤并发周围神经伤，传统的修复术只有２０％～５０％的疗效，采用显微外科技术后优良率可达９０％。显微外科修复术包括神经松解术、束膜切开术、神经缝合术、神经移位术及神经植入术等。首先采用显微外科技术...     

端侧吻合修复周围神经缺损的研究进展

周围神经端侧吻合是周围神经损伤修复方法之一,它不同于经典的神经端端吻合,而是将损伤神经的远侧断端缝合到相邻健康的神经干侧壁上,或取一神经段以端侧吻合的方式桥接于损伤神经和正常神经之间。1901年国外学者首先提出周围神经端侧吻合术可弥补神经移植的缺陷。时至今日,国内外已有许多相关研究的报道。本文就端侧吻合术的动物实验与临床研究作一综述。     

非神经材料桥接周围神经缺损的研究进展

周围神经缺损的治疗一直是人们研究的课题。自体神经移植虽是较有效的方法,但供区有限,长度和直径难以与受区相符,可遗留供区感觉障碍等缺点。因此,不少学者试图寻找非神经材料修复神经缺损。现将这方面的研究进展介绍如下。 一、发展过程 非神经材料桥接周围神经的研究已有一百多年的历史,Gluck(1880)和Vanlair(1882)最早     

Overcoming short gaps in peripheral nerve repair: conduits and human acellular nerve allograft

Nerve conduits and acellular nerve allograft offer efficient and convenient tools for overcoming unexpected gaps during nerve repair. Both techniques offer guidance for migrating Schwann cells and axonal regeneration though utilizing very different scaffolds. The substantially greater amount of animal and clinical data published on nerve conduits is marked by wide discrepancies in results that may be partly explained by a still poorly defined critical repair gap and diameter size. The available information on acellular allografts appears more consistently positive though this tool is also hampered by a longer but also limited critical length. This article reviews the current relative literature and examines pertinent parameters for application of both acellular allograft and nerve conduits in overcoming short nerve gaps.     

Repair and reconstruction of peripheral nerve injuries

Axonal regeneration after transection is a complex biological process. It is not merely a process of tissue repair, but rather of cellular repair of a large number of nerve cells. Regeneration involves restoration of the original morphology of each single cell, rather than proliferation. Techniques in microneurosurgical reconstruction of peripheral nerve injuries have improved over the last two decades, with subsequent improvement in functional results. Nerve autografts are now routinely used to guide the regrowth of the proximal nerves to distal nerve segments. However, the limited source of expendable cutaneous nerves restricts the use of nerve grafting techniques and is associated with significant morbidity. With extensive injuries there is an insufficient quantity of nerve autograft material to facilitate optimal repair. In future, the use of artificial conduits or nerve allografts could provide a limitless source of material to reconstruct otherwise irreparable traumatic nerve injuries. Establishment of appropriate strategies to suppress host-immune reaction or donor antigenicity would facilitate clinical allogeneic nerve transplantation. Guest lecture presented at the 69th Annual Meeting of the Japanese Orthopaedic Association in Tokyo on April 13, 1996.     

Sensory recovery following decellularized nerve allograft transplantation for digital nerve repair

Abstract

This study reported preliminary clinical experience of using decelluarised nerve allograft material for repair of digital nerve defect in five hand injury patients. From October 2009 to July 2010, five patients with traumatic nerve defect were treated with nerve repair using AxoGen® nerve allograft (AxoGen Inc, Alachua, FL) in California Hospital Medical Center. All patients were followed at least for 12 months, and sensory recovery and signs of infection or rejection were documented by a hand therapist. Average two-point discrimination was 6 mm, and average Semmes-Weinstein Monofilaments test was 4.31. No wound infections or signs of rejections were observed at wound site. All patients reported sensory improvement during the follow-up period after operation. It is believed that decellularised nerve allografts may provide a readily available option for repair of segmental nerve defect.     

改良化学去细胞同种异体神经制备方法的实验研究

[目的]改进去细胞异体神经化学萃取制备方法，制备出细胞及髓鞘去除完全、神经机构保存完好的去细胞异体神经移植物。[方法]SD大鼠14只，取双侧坐骨神经（共28根），分3组进行化学萃取去细胞处理：Son．dell法组（10根）、改良法组（10根）和对照组（8根）。Sondell法组所用萃取剂为TritonX-100和脱氧胆酸钠；改良法组所用萃取剂为TritonX-200、SB-10和SB-16；对照组未进行化学处理。处理后神经行HE染色、快蓝染色、基底膜素免疫组化染色及环境扫描电镜观察，并从去细胞程度、髓鞘染色分级和结构完整性三方面综合评价。[结果]在去细胞异体神经物理性状方面，改良法制备的去细胞异体神经韧性弹性略好于Sondell法；HE染色表明，2种方法的去细胞效果均较好，但改良法对神经结构的破坏较小；快蓝染色、基底膜素免疫组化染色、环境扫描电镜结果均表明，改良法在对髓鞘的去除、基底膜素的保留及神经结构的保存方面均优于Sondell法；综合质量评分结果表明，2种方法在去细胞效果方面相似（P1〉0．05），髓鞘去除及神经结构的保存方面改良法优于Sondell法（P2、P3〈0．05），综合去细胞程度、髓鞘染色分级和结构完整性3方面，改良法制备的去细胞异体神经质量优于Sondell法（p4〈0．05）。[结论]综合运用萃取剂TritonX-200、SB-10和sB-16的化学萃取方法，是一种较为理想的去细胞异体神经制备方法，能够制备出免疫物质清除完全、神经结构较好保存的去细胞异体神经移植物，为自体神经移植找到了较好的替代解决方法。     

Large-gap peripheral nerve repair using xenogeneic transplants in rhesus macaques

Surgical intervention is required to successfully treat severe, large-gap (≥4 cm) peripheral nerve injuries. However, all existing treatments have shortcomings and an alternative to the use of autologous nerves is needed. Human and porcine nerves are physiologically similar, with comparable dimensions and architecture, presence and distribution of Schwann cells, and conserved features of the extracellular matrix (ECM). We report the repair of fully transected radial nerves in 10 Rhesus Macaques using viable, whole sciatic nerve from genetically engineered (GalT-KO), designated pathogen free (DPF) porcine donors. This resulted in the regeneration of the transected nerve, and importantly, recovery of wrist extension function, distal muscle reinnervation, and recovery of nerve conduction velocities and compound muscle action potentials similar to autologous controls. We also demonstrate the absence of immune rejection, systemic porcine cell migration, and detectable residual porcine material. Our preliminary findings support the safety and efficacy of viable porcine nerve transplants, suggest the interchangeable therapeutic use of cross-species cells, and highlight the broader clinical potential of xenotransplantation.     

Repair of peripheral nerve defect with direct gradual lengthening of the proximal nerve stump in rats.

We investigated the effect of direct gradual lengthening on the proximal nerve stump and subsequent nerve regeneration in rats. A 10-mm-long nerve segment was resected from the sciatic nerve of each rat. The proximal nerve stump was directly lengthened at a rate of 1 mm/day using an original external nerve distraction device. Experiment I: After distraction periods of 10, 15, and 20 days, the length of each nerve was evaluated, and the lengthened nerve stump was also examined by immunohistochemical analysis. Experiment II: After a distraction period of 20 days, both nerve stumps were refreshed and direct end-to-end neurorrhaphy was performed. For control, 10-mm nerve grafting was immediately performed after nerve resection. Nerve regeneration was evaluated electrophysiologically and histologically 7, 9, and 15 weeks after nerve resection in both groups. The whole proximal nerve stump, including the endoneurium and the axon, could be lengthened in proportion to the distraction period. There were no significant differences in motor nerve conduction velocity and tetanic muscle contraction force between both groups. Histologically, the total number of myelinated fibers was significantly greater in the nerve lengthening group than in the autografting group. This study demonstrated that the whole proximal nerve stump including the endoneurium and the axon could be lengthened by direct gradual distraction, and that this method might have potential application in the repair of peripheral nerve defects.     

面神经损伤修复方法的研究进展

面神经是含有运动神经纤维和感觉神经纤维的混合神经,并以运动功能为主,易受外伤、医源性损伤、肿瘤等因素影响而造成损伤,随着修复技术的提高,面神经损伤修复的质量大为提高。但由于面神经解剖和功能上的特殊性,且神经再生是一个复杂的过程,修复后功能的恢复不够理想。因此,寻找新的修复方法提高神经的再生速度和质量,依然是目前需要解决的问题。现将面神经损伤修复方法的研究进展综述如下。