脱细胞同种异体神经移植物修复大鼠坐骨神经缺损的实验研究

目的 观察脱细胞处理的同种异体神经移植物修复大鼠坐骨神经缺损的作用。方法 用组织工程学方法制备的大鼠同种异体神经移植物桥接大鼠坐骨神经缺损，并对再生神经进行电生理学功能测试，光镜、电镜观察移植物内的再生神经，并进行统计分析。结果 术后13周内，动物未见炎症及排斥反应。用脱细胞处理的同种异体神经移植物修复神经缺损，再生神经的传导功能、纤维数量、轴突直径、有髓纤维占有的面积与自体神经移植对照及计量学上统计分析均无显著性差异。结论 脱细胞处理的同种异体神经移植物具有良好的组织相容性，它对缺损的坐骨神经再生有促进作用。     

去细胞神经与自体神经移植桥接修复大鼠坐骨神经缺损的对比研究

目的观察同种异体去细胞神经与自体神经移植桥接修复大鼠坐骨神经缺损的神经再生情况。方法制备大鼠同种异体去细胞神经及大鼠坐骨神经缺损模型,修复12周后应用HE染色,Bielschowsky改良染色,Weil氏铁明矾苏木素染色,光镜下观察神经外膜上的微血管数和微血管面积百分比,计数单位面积的轴突数目,远端轴突密度/近端轴突密度为再生神经通过率,计数单位面积的有髓神经纤维数目和有髓神经纤维的直径。结果在坐骨神经纤维的再生神经纤维通过率、有髓神经纤维密度和直径、桥接体微血管的数目和微血管面积百分比等再生指标上,自体神经移植组略优于化学去细胞神经组。结论同种异体去细胞神经移植可促进神经再生,但仍然不如自体移植效果好。     

同种异体神经复合体修复兔周围神经缺损

背景：应用种植许旺细胞的去细胞同种异体神经复合体修复周围神经缺损,探索其对神经再生及功能恢复有更好的促进作用,并且免疫原性非常小。 目的：用种植胎兔许旺细胞的去细胞同种异体神经复合体修复兔缺损的坐骨神经,观察移植神经周围免疫细胞的变化及功能恢复。 　 方法：48只新西兰白兔随机分成实验组和对照组。两组动物均切除一段坐骨神经,造成2.0 cm长的缺损,实验组用种植胎兔许旺细胞的同种异体神经复合体修复坐骨神经;对照组仅用去细胞同种异体神经修复。移植后1,4,8周光镜观察移植段坐骨神经周围肌肉组织中免疫细胞的浸润情况,计数每个高倍视野免疫细胞的数量。移植后4,8,16周大体观察兔的足部溃疡形成及愈合情况,大体观察神经愈合情况;肌电图检查桥接段坐骨神经的传导速度。 结果与结论：手术区局部均未出现明显的排斥反应,实验组足部溃疡愈合情况优于对照组。移植后1周移植段坐骨神经周围肌肉组织中有大量淋巴细胞及巨噬细胞浸润,实验组明显多于对照组(P < 0.05);移植后4周,浸润的免疫细胞两组均较1周后明显减少,实验组减少更明显。移植后8周,浸润的免疫细胞更加减少,但两组间比较差异无显著性意义(P > 0.05)。移植后4周时,两组均未见明显的神经传导,8,16周神经传导速度实验组均优于对照组(P < 0.05)。提示,种植许旺细胞的去细胞同种异体神经复合体免疫原性非常小,对神经再生及功能恢复有更好的促进作用。     

富血小板血浆诱导骨髓间充质干细胞结合化学萃取去细胞神经修复坐骨神经缺损

背景:周围神经损伤早期许旺细胞尚未大量分裂增殖,此时由于解剖连续性的中断,通过轴浆逆向运输提供的营养因子骤减,缺乏神经营养因子支持的神经元有可能死亡,从而使周围神经不能再生或再生乏力。目的:观察植入经富血小板血浆诱导的骨髓间充质干细胞结合去细胞神经修复坐骨神经缺损的效果。方法:取新西兰大耳白兔制备坐骨神经缺损模型,随机抽签法分成4组:去细胞神经组,移植同种异体去细胞神经;骨髓间充质干细胞组,移植同种异体骨髓间充质干细胞结合化学萃取的同种异体去细胞神经:经诱导骨髓间充质干细胞组,移植经富血小板血浆诱导的同种异体骨髓间充质干细胞结合化学萃取的同种异体去细胞神经;自体神经组,移植自体神经。术后进行形态学观察与靶肌肉肌湿质量恢复率、运动神经传导速度、轴突直径和髓鞘厚度的检测。结果与结论:经富血小板血浆诱导的骨髓间充质干细胞结合化学萃取的去细胞神经移植修复神经的靶肌肉肌湿质量恢复率、运动神经传导速度、轴突直径和髓鞘厚度及形态学观察明显优于移植单纯化学萃取的去细胞神经与骨髓间充质干细胞结合化学萃取的去细胞神经的效果,而与移植自体神经修复结果相似。说明经诱导后的骨髓间充质干细胞在体内具有许旺细胞的部分功能,可作为组织工程化外周神经的种子细胞,用于周围神经缺损的修复。     

以化学去细胞法处理同种异体神经与周围静脉伴行修复面神经缺损

背景：有研究表明化学去细胞法处理的同种异体神经修复面神经缺损可以取得较好的修复效果。 目的：在化学去细胞法处理同种异体神经的基础上探索一种修复面神经缺损更有效的修复方式。  方法：将新西兰大白兔随机分为2组,实验组制备面神经颊支缺损动物模型,采用经化学去细胞的同种异体腓肠神经进行移植,且与伴行静脉行外膜缝合;对照组在同样位置的远近端分别切断面神经,但不破坏被切断神经与周围组织的正常解剖关系,再切断处行外膜缝合桥接。 结果与结论：修复后3个月两组兔均存活,面部表情基本对称,胡须活动正常,神经移植处未见明显瘢痕及神经瘤形成。电镜观察结果显示,实验组与对照组右侧面神经颊支传导速度,移植体远端吻合口附近5.0 mm段有髓神经纤维数量,靶肌肉运动终板计数均差异无显著性意义(P > 0.05)。结果证实,化学去细胞同种异体神经与周围静脉伴行修复家兔面神经缺损的方法可以达到与自体面神经原位移植相似的修复效果。     

无细胞神经移植物复合骨髓间充质干细胞构建组织工程人工神经修复坐骨神经缺损

背景:作者前期已经成功将无细胞神经移植物复合骨髓间充质干细胞构建组织工程人工神经,并证明可以促进周围神经再生。目的:构建组织工程人工神经,观察和验证桥接大鼠坐骨神经缺损后的神经功能恢复情况。方法:成年雄性SD大鼠60只构建大鼠坐骨神经15mm缺损模型。随机分成3组,每组20只。桥接大鼠坐骨神经缺损,实验组采用组织工程人工神经,空白对照组采用无细胞组织工程神经支架,自体神经对照组采用自体神经移植。桥接后12周通过大体观察、胫骨前肌湿质量、组织学等方法分析坐骨神经组织学及功能恢复情况。结果与结论:桥接术后12周:实验组大鼠肢体可以支撑着地,钳夹大鼠手术侧足底皮肤出现逃避反射,足底皮肤s-100蛋白染色呈阳性反应。实验组与自体神经移植组胫骨前肌湿质量比差异无显著性意义(P0.05)。实验组辣根过氧化物酶逆行示踪实验显示脊髓、后根神经节均可见数量不等的辣根过氧化物酶标记阳性细胞。实验组移植物与自体神经移植组有髓神经纤维数、髓鞘厚度、神经组织面积比较差异无显著性意义。实验结果验证了无细胞神经移植物复合骨髓间充质干细胞构建组织工程人工神经修复大鼠坐骨神经缺损,可以促进神经组织学的修复重建和功能的恢复。     

人工组织神经移植物对大鼠陈旧性坐骨神经缺损(60天)的修复作用

目的 观察人工组织神经移植物对陈旧性大鼠坐骨神经缺损的修复作用.方法 切除成年SD大鼠部分左侧坐骨神经,饲养60d形成陈旧性坐骨神经缺损后,以人工组织神经移植物修复缺损,同时设自体神经修复和不修复两对照组.修复术后3个月做神经-肌复合电位、腓肠肌湿重及再生神经形态学检测.结果 人工组织神经移植物修复组实验侧的运动神经传导速度、腓肠肌湿重、移植物远侧再生神经有髓神经纤维髓鞘厚度等结果与自体神经修复组相似.不修复对照组则未记录到神经-肌复合电位,未观察到再生神经纤维结构,腓肠肌湿重明显小于人工组织神经移植组和自体神经移植组.结论 人工组织神经移植物在一定程度上能修复缺损60d的大鼠坐骨神经.     

化学去细胞同种异体神经移植修复大鼠骶1神经缺损

背景：自体神经移植是修复周围神经损伤中最常用的方法。 目的：探讨化学去细胞神经修复大鼠骶1神经缺损的效果,以期寻找修复周围神经缺损较为理想的方法和材料。 方法：取SD大鼠骶1神经,采用化学去细胞法处理大鼠骶1神经的免疫原性成分,使其成为去细胞神经。将Wistar大鼠右侧骶1神经制成1 cm缺损模型,用SD大鼠去细胞同种异体神经移植修复大鼠骶1神经的缺损。 结果与结论：与术前相比,术后8周逼尿肌漏尿点降低,膀胱最大容积和膀胱顺应性升高(P < 0.05)。神经纤维细丝蛋白染色结果显示,右侧经同种异体神经移植修复的神经吻合口断端被染成绿色,神经纤维排列整齐分布均一,再生神经轴突长入远端神经。左侧正常神经形态均一,神经纤维排列整齐分布均一未见轴突长入远端神经。结果表明,化学去细胞同种异体神经的抗原性明显降低,可修复高等哺乳类动物的周围神经损伤。     

大鼠坐骨神经缺损半个月后人工组织神经移植物修复的实验研究

为了观察人工组织神经移植物对大鼠坐骨神经非新鲜损伤的修复作用。我们在成年SD大鼠左侧股中部切除部分坐骨神经制造神经缺损模型。15d后,实验组(9只)用人工组织神经移植物修复神经缺损,自体神经修复作为阳性对照(6只),保持神经缺损为阴性对照(6只)。第二次手术后3个月,电生理学、形态学结果显示实验组的再生神经虽略差于自体对照组,但明显优于缺损对照组,腓肠肌的萎缩形态学指标变化则较接近自体对照组。实验结果表明人工组织神经移植物对已缺损15d的大鼠周围神经具有较好修复作用。     

去细胞异体神经的形态结构及移植后的组织相容性

目的:为面神经缺损寻找一种理想的异体神经移植物。方法:取Wistar大鼠胫神经,经Triton X-100和脱氧胆酸钠溶液进行化学去细胞处理。将处理后的神经行组织学染色和免疫组织化学染色;并行异体移植修复面神经缺损,观察其组织相容性。结果:去细胞神经为一中空的神经基质管,其中的细胞和髓鞘成分被有效清除,神经基底膜被保留;异体移植后无明显炎症反应,无排斥和吸收反应,能引导宿主轴突和Schwann细胞增殖。结论:去细胞异体神经移植物具有良好的仿生性和组织相容性,可能用于修复面神经缺损。     

bFGF对同种异体神经移植后周围神经再生的影响

目的 :探讨bFGF对同种异体神经移植后周围神经再生的影响。方法 :将反复冻融的大鼠神经移植于另一大鼠的坐骨神经 ,实验组注射bFGF 1 0 0u/d共 1 0d ,对照组注射生理盐水 1 0d。术后大鼠存活 1 2周 ,光镜下用体视学方法测试再生神经纤维的面数密度 (NA)、面积密度 (AA)、横切面面积 (AE)、脊髓前角运动细胞和脊神经节细胞的体密度 (VV)、数密度 (NV)。结果 :两组均可见再生神经纤维长入异体移植神经并向远段延伸。实验组再生神经纤维的NA、AA、脊髓前角运动细胞和脊神经节细胞的VV、NV 与对照组的比较 ,有显著性差异。结论 :bFGF能促进周围神经再生 ,对脊髓前角运动细胞和脊神经节细胞的存活有保护作用。     

组织工程化神经导管修复外周神经损伤

背景：神经导管技术理论上采用生物或非生物材料预制成合适的管状支架,桥接神经断端两侧,在提供神经再生微环境的同时通过神经诱导、营养作用促进神经再生。 目的：观察组织工程化神经导管修复外周神经损伤的临床效果。 方法：选择24例陈旧性上肢神经损伤患者,以患者自愿原则分2组治疗：试验组采用组织工程化神经导管修复,对照组采用自体周围体表感觉神经移植修复。治疗后随访6个月观察患者肢体神经损伤功能修复效果。 结果与结论：随访6个月后,两组肢体远端感觉运动功能与目测类比疼痛评分均较治疗前改善(P < 0.05),且试验组效果更好(P < 0.05);两组损伤侧感觉与运动神经传导速度均较治疗前改善(P < 0.05),且两组间差异无显著性意义。说明组织工程化神经导管材料符合神经修复导管支架的要求,临床应用疗效肯定。     

臀下神经转位阴部神经的应用解剖

目的：为重建单纯脊髓圆锥或阴部神经损伤后的会阴部功能提供解剖学基础。方法：对成人尸体的臀下神经和阴部神经进行了观测。结果：臀下神经以1支(45．00％)或2支(46．67％)从盆腔穿出为多，其中85．00％穿梨状肌下孔；其穿出点的位置主要在髂后上棘与坐骨结节连线的中1／3(50．00％)或上、中1／3交界处(48．33％)。神经干的长大于3cm，与阴部神经穿出处相距仅约2cm。阴部神经出盆处主要在髂后上棘与坐骨结节连线中1／3(46．67％)或中、下1／3交界(50．00％)。结论：两神经出盆处位置接近，臀下神经的长度足以直接与阴部神经缝接，用脊髓起源节段高的臀下神经转位脊髓起源节段低的阴部神经，切实易行。     

Variation of the spinal nerve compositions of thoracodorsal nerve

Thoracodorsal nerve distributes to the latissimus dorsi muscle. The aim of this study was to investigate the anatomic variation of the spinal nerve compositions of thoracodorsal nerve and to confirm which spinal nerve is a main component in participating amount. The most frequent type was consisted of C7 and C8 in 60%. Next frequent type was C6, C7, and C8 in 25%. Third type was C6 and C7 in 10% and fourth type was C7 alone in 5%. The diameter of each spinal nerve comprising thoracodorsal nerve was 1.20 +/- 0.23 (mean +/- SD) mm at C7, 0.43 +/- 0.15 mm at C8, and 0.33 +/- 0.09 mm at C6. These results show that the C7 nerve was the main component of thoracodorsal nerve and the anatomic variation appeared at the spinal nerve that participate by small amounts, as be excepted (C6 and C8).     

Sural-tibial nerve communications in humans

We investigated the occurrence of a communication between the sural and tibial nerves in 49 legs of 28 Japanese cadavers. In front of the calcanean tendon, we found the communication in 7 legs (14.3%) or in 5 cadavers (18.9%). The sural nerve gave rise to a number of medial and lateral branches, including the lateral calcanean branch at the lateral side of the ankle. The communicating branch with the tibial nerve arose from the first medial branch and pierced the deep fascia of the leg. In 4 cases, the U-shaped communication was formed between the sural and tibial nerves, and in 3 cases, the Y-shaped communication. Electrophysiologi-cal evidence of an anomalous motor function of the sural nerve has been reported recently. We consider that the U-shaped communication between the sural and tibial nerves gives a morphological basis to the motor function of the sural nerve.     

手掌分区与正中神经和尺神经

目的：为研究手掌病变、作神经吻合及阻滞麻醉提供解剖学基础。方法：手掌借5条横平行线和掌纵纹，分为桡、尺两部及6个区。解剖并观察正中神经和尺神经在手掌各区的分支及分布。结果：正中神经掌皮支和主支位于Ⅰ、Ⅱ区，主支在Ⅲ区形成4种形态的伞形结构，在C线处发出第1～3指掌侧总神经。正中神经返支由伞形结构桡侧发出，经B1点入大鱼际。尺神经主支和掌皮支位于Ⅰ区。浅支在A1点分为指掌侧总神经和小指掌侧固有神经，深支于A1点入手掌Ⅱ区深面。指掌侧总神经在E线分为指掌侧固有神经。结论：手掌神经有按区分布的特点，有助于手掌损伤离断神经的寻找和吻合，以及手掌神经阻滞麻醉的精确定位。     

Functional anatomy of the mandibular nerve: consequences of nerve injury and entrapment

Various anatomic structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN). The infratemporal fossa is a common location for MN compression and one of the most difficult regions of the skull to access surgically. Other potential sites for entrapment of the MN and its branches include, a totally or partially ossified pterygospinous or pterygoalar ligament, a large lamina of the lateral plate of the pterygoid process, the medial fibers of the lower belly of the lateral pterygoid muscle and the inner fibers of the medial pterygoid muscle. The clinical consequences of MN entrapment are dependent upon which branches are compressed. Compression of the MN motor branches can lead to paresis or weakness in the innervated muscles, whereas compression of the sensory branches can provoke neuralgia or paresthesia. Compression of one of the major branches of the MN, the lingual nerve (LN), is associated with numbness, hypoesthesia, or even anesthesia of the tongue, loss of taste in the anterior two thirds of the tongue, anesthesia of the lingual gums, pain, and speech articulation disorders. The aim of this article is to review, the anatomy of the MN and its major branches with relation to their vulnerability to entrapment. Because the LN expresses an increased vulnerability to entrapment neuropathies as a result of its anatomical location, frequent variations, as well as from irregular osseous, fibrous, or muscular irregularities in the region of the infratemporal fossa, particular emphasis is placed on the LN.     

Comparison of greater occipital nerve and greater occipital nerve + supraorbital nerve block effect in chronic medication overuse headache

Background /aimIn this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH).Material and methods82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected.ResultsThe decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 ±  0.7, 8.5  ± 0.7), the number of painful days in a month was (21.4 ±  6.9, 21.2 ± 4.6 days), the number of analgesics taken monthly was (45 ±  25.6, 47.5 ±  29.9), the duration of pain was (44.9 ±  24.6, 41.7 ±  22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 ±  2.5, 4.8 ± 2.3), the number of painful days in a month was (4.2 ±  3.3, 2.2 ±  1.5), respectively. The number of monthly nalgesic consumption was (4.4 ±  3.8, 0.9 ±  1.2), and the duration of pain was (28.4 ±  19.3, 19.4  ± 16.1 h).ConclusionThis study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.     

Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses

The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.     

腋神经和桡神经与肱骨的关系及其临床意义

目的　观测腋神经、桡神经与肱骨骨性标志的关系 ,为肱骨手术或外固定提供帮助。方法　在 30例 6 0侧成人上肢标本上观、测了腋神经、桡神经与肱骨有关骨性标志的距离。结果　肱骨最大长 (30 6 6 5± 17 4 8)mm ;肱骨最近端到腋神经(5 8 10± 5 6 1)mm ;肱骨最近端到桡神经穿外侧肌间隔处 (177 75± 11 86 )mm ;解剖颈最低点到腋神经 (16 2 4± 2 78)mm ;肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm ;并测量计算了各段占肱骨最大长的比例。结论　腋神经在肱骨近端 1/ 5处容易受损 ,而桡神经在肱骨下 3/ 5段为易损伤部。从术前和术中的影像 ,能测量和计算出神经的基本位置 ,可减少或避免神经损伤