不同病理类型的臂丛神经损伤后变性神经中S—100蛋白？…

目的 探讨不同病理类型的壁丛神经损伤后变性神经中Ｓ－１００蛋白的变化规律，为临床进行术中检测与判定提供理论依据，以进一步指导临床，提高壁丛神经损伤的诊治效果。方法 建立ＳＤ大鼠不同病理类型的臂丛神经损伤，用免疫组织化学方法分别在损伤后１、２、３和６个月检测变性的远端神经中Ｓ－１００蛋白的分布和含量变化。结果 Ｓ－１００蛋白主要沿轴突四周分布，节后组损伤１个月后Ｓ－１００蛋白呈阴性反应，而节前组术后     

臂丛神经节前损伤的大鼠动物模型

目的：介绍大鼠臂丛神经节前损伤动物模型的设计及实验结果。方法：选用ＳＤ大鼠，通过扩大椎间孔撕脱脊神经节，造成臂丛神经节前损伤模型（实验组），用组织病理学方法观察神经节内神经元细胞的变化，并用免疫组化方法，检测神经中Ｓ－１００蛋白阳性轴突数及灰度。结果：节前损伤模型可见撕脱的神经节，术后 １个月仍能见到神经节及神经元细胞； Ｓ－ １００蛋白阳性轴突在术后 １个月仍有表达；而节后损伤（对照组）到术后１个月则未见Ｓ－１００蛋白阳性轴突。结论：为臂丛神经损伤的深入研究提供一个具有科学性及合理性的实验模型。     

不同病理类型臂丛损伤后变性神经中胶原的变化

目的研究不同病理类型的臂丛损伤后变性神经中胶原蛋白的变化规律。方法建立ＳＤ大鼠不同病理类型的臂丛损伤模型，用免疫组织化学和电镜方法，分别检测变性的远端神经中Ｉ型蛋白含量的变化及观察胶原纤维的超微结构。结果胶原含量在节前组中术后６个月组略上升，节后组术后１个月组即开始上升，３个月以上上升显著。节后组胶原含量多于节前组（Ｐ＜０．０１）。结论节前损伤远端神经中胶原增生较节后损伤轻且速度缓慢     

膈神经副神经肌电图检查对提高臂丛神经根性损伤诊断符合率的机制和意义

目的阐明膈神经、副神经肌电图检查对提高臂丛神经根性损伤诊断符合率的机制和意义。方法对１００例术中证实为全臂丛或上中干根性损伤的术前肌电图资料（包括膈神经、副神经和臂丛神经）进行分析，总结Ｃ５神经根性损伤中节前、后的发生率，术前诊断符合率及膈神经、副神经的功能。结果１００例臂丛神经根性损伤中，Ｃ５神经根性损伤的诊断符合率为８７％，比过去提高３１．９％；节后损伤的诊断符合率为８１．９％，提高３０．８％。膈神经、副神经完全损伤者Ｃ５神经根均为节前损伤。膈神经完全损伤１３例，不全损伤７例中５例（７１．４％）为节前损伤；副神经完全损伤５例，不全损伤１４例中８例（５７．１％）为节前损伤。结论对膈神经、副神经进行肌电图检测，可提高Ｃ５神经根性损伤的术前诊断符合率；并可判断膈神经、副神经的功能是否适合作神经移位术的动力神经     

膈神经副神经肌电图检查对提高臂丛神经根性损伤诊断符合率 …

目的 阐明膈神经、副神经肌电图检查对提高臂丛神经根性损伤诊断符合率的机制和意义。方法 对１００例术中证实为全臂丛或上中干根性损伤的术前肌电图资料（包括膈神经、副神经和臂丛神经）进行分析，总结Ｃ５神经根性损伤中节前、后的发生率，术前诊断符合率及膈神经、副神经的功能。结果 １００例臂丛神经根性损伤中，Ｃ５神经根性损伤的诊断符合率为８７％，比过去提高３１．９％；节后损伤的诊断符合率为８１．９％，提高３０     

臂丛神经损伤的手术治疗

臂丛神经损伤是常见严重损伤,我院自1962年至1995年间共手术3064例,其中节后损伤1288例,节前损伤1756例。节后损伤预后一般较好,而节前损伤预后较差,如何提高节前损伤的诊治水平是国际共同探讨的难题,目前已开展的神经移位有肋间神经,     

臂丛神经根性撕脱伤诱发的灼性神经痛的特点与机制

由周围神经损伤引起的神经病理性痛是临床常见的慢性疼痛,涉及的病理过程繁多,发生机制极为复杂[1-3].臂丛神经损伤属严重的周围神经损伤,根据损伤部位可分为节后和节前损伤两类.节后损伤指脊髓背根神经节远侧臂丛分支的损伤,临床上少有发生严重肢体疼痛.节前损伤即根性损伤,指发生于脊髓背根神经节神经元中枢突,以撕脱伤最为严重,常伴有严重的灼性神经痛[4].本文就臂丛神经根性撕脱伤灼性痛的特点、机制和临床治疗进展做一综述.     

臂丛神经损伤的显微外科治疗

目的：回顾性分析应用显微外科技术治疗臂丛神经损伤的疗效。方法：从１９８４年５月至１９９４年５月共治疗臂丛神经损伤患者１０５例，手术方法包括神经松解术、神经直接缝合术、神经移植术和神经转移术。结果：５４例经１年以上随访，功能恢复优良率达５８．２５％。结论：临床资料表明，（１）开放性臂丛损伤应尽早修复，而闭合性的可保守治疗观察３～６个月；（２）当神经断裂时应尽量利用近端残留的神经根或干优先修复远端重要的神经束，同时，即使长度超过１０ｃｍ的神经段移植亦可获得较好的效果；（３）术后要作长期的随访观察，以便检查术后功能恢复情况和决定是否需要采取其他补救措施。     

健侧C_7神经根移位后健侧肢体功能的观察

我们对１例行健侧Ｃ７神经根移位术患者，术后健侧肢体的功能，进行追踪观察，报道如下。患者男，３１岁。１９９３年３月６日被汽车迎面相撞后昏迷不醒，经抢救５小时后清醒。查体发现左侧肱骨中段骨折，左上肢感觉、运动功能完全消失，Ｈｏｒｎｅｒ征（＋）。肌电图检查：左上肢各肌均呈失神经电位改变，Ｃ５－８Ｔ１，感觉神经检测ＳＮＡＰ存在，ＳＥＰ消失，揭示ｃ５－８Ｔ１节前损伤。诊断为全臂丛神经根性损伤。保守治疗３个月无效，于１９９３年６月７日行多组神经移位术，半年后肩部及肘部活动有所恢复。于１９９３年１１月８日再行…     

对臂丛神经节前损伤后行神经移位肌内种植术的评价

对移位神经肌内种植术治疗臂丛节前损伤的疗效作一评价。方法：１９９０年间共手术治疗臂丛神经损伤３０２例。其中１０例，术中发现不仅臂丛神经根性撕脱，而且神经远瑞缺损；选用膈、副、肋间、颈丛运动支作为移位神经，经神经移植种植于三角肌５块，肱二头肌４块，肱三头肌１块，胸大肌１块。术后４年进行随访，检测其有关肌肉肌力的恢复程度。结果：肌力恢复２度６块，１度３块，０度２块。结论：该法的治疗效果欠佳，有待进一步提高     

后根轴突再生重建感觉传入通路的实验研究

目的 将后根分别与脊神经节中枢突支(后根)和周围突支(脊神经)吻合,为通过后根再生重建感觉传入通路奠定组织学基础.方法 SD大鼠74只随机分为三组,左侧为正常对照侧,右侧为手术侧.A组将L4后根近断端L6后根远断端吻合;B组将L4脊神经出椎间孔2 mm处切断,近断端与L6后根远断端吻合;C组手术操作同B组,但不吻合作为假手术组.术后3个月以逆行神经示踪、脊髓后根入口(dorsal root entry zone,DREZ)降钙素基因相关肽(calcitonin gene-related peptide,CGRP)阳性轴突分布、脊神经节和脊髓后角神经元存活率、光镜和透射电镜评价轴突再生效果.结果 逆行神经示踪证实B组再生轴突轴浆运输功能恢复良好.A组和B组均可见轴突再生通过吻合口,神经纤维数量和髓鞘厚度与正常对照侧比较差异无统计学意义;但A组轴突再生停止于DREZ,脊髓后角CGRP阳性纤维分布密度低于B组和正常对照侧,差异有统计学意义.三组L6脊神经节神经元存活率与正常对照侧比较差异无统计学意义;A组和C组L4脊髓后角神经元存活率低于B组和正常对照侧,差异有统计学意义.结论 后根与脊神经吻合后不影响脊髓后角神经元存活,神经纤维再生、轴浆运输能通过DREZ进入脊髓,是一种理想的修复感觉传导通路的方式.

Abstract：

Objective To provide the morphological evidence for sensory pathway by the repair of dorsal root (DR) in which received transected and anastomosed with central processes (DR) and peripheral processes (spinal nerve) respectively. Methods 74 SD rats were divided into three groups randomly. Group A: the distal ending of L6 DR was sutured to the proximal ending of the L4 DR in right side. Group B: the postganglionic spinal nerve of L4 was cut at a point 2 mm to intervertebral foramen and its proximal stump was reconnected to the distal ending of L6 DR in right side. Group C: under the same operative manipulation on group B, but no anastomosis was performed to serve as the sham operation group. The left side was kept intact and served as a normal control in all groups. The repairing results of DR axonal regeneration were evaluated at 3 months after operation by retrograde tracing, the density of positive Calcitonin gene-related peptide (CGRP) axon in dorsal root entry zone (DREZ), survival rate of neurons in DR ganglia and posterior horn, light and transmission electron microscope. Results HRP retrograde tracing demonstrated axonal axoplasmic transport of regenerative nerve recovered well in group B. Regenerative fibers were found. There was no difference between group A or B and normal control with regard to the number of myelinated axons and the thickness of myelin. Regenerating axon stop at the DREZ in group A and the density of positive CGRP were lower than those in group B and normal control. Survival rate of neurons in L6 DR ganglia had no difference among all groups. However, in posterior horn, a significant increase in death was seen in group A and sham group. Conclusion The ability of axonal regeneration was effective and with no disservice to neurons in posterior horn following anastomosis of postganglionic spinal nerve and dorsal root, by which axoplasmic transport across the DREZ into the spinal cord.     

End-to-side nerve repair: review of the literature and clinical indications

End-to-side (ETS) nerve repair, in which the distal stump of a transected nerve is coapted to the side of an uninjured donor nerve, has been suggested as a technique for repair of peripheral nerve injuries where the proximal nerve stump is unavailable or a significant nerve gap exists. Full review of the ETS literature suggests that sensory recovery after ETS repair results in some, but not robust, regeneration. Sensory axons will sprout without deliberate injury. However, motor axons only regenerate after deliberate nerve injury. Experimental and clinical experience with ETS neurorrhaphy has rendered mixed results. Continued research into ETS nerve repair is warranted. ETS techniques should not yet replace safer and more reliable techniques of nerve repair except when some, but not good, sensory recovery is appropriate and a deliberate injury to the donor motor nerve is made.     

The influence of motor axon misdirection on muscle contraction force in early nerve repair in a rat sciatic nerve model.

We examined the influence of misdirection of regenerating motor axons toward the distal sensory Schwann tubes on the muscle contraction force in early nerve repair using a rat sciatic nerve model. At 0, 1, 2, 4 and 8 weeks after severing the tibial, peroneal and sural nerves, the proximal stump of the tibial nerve was anastomosed with the distal stumps of both the peroneal and sural nerves using tubulisation (n=10 in each of five groups). We intentionally used the distal stump of the sural nerve (a sensory nerve) to induce regeneration in motor axons from the proximal tibial nerve stump toward the distal sensory nerve stump. Twenty-four weeks after nerve repair, isometric contraction force and wet weight of the anterior tibial muscle were measured, and the numbers of regenerated myelinated axons (motor and sensory) in the distal sural and peroneal nerves were counted. The rates of sural nerve regeneration were significantly higher at weeks 0 and 1 than at the later repair times. However, muscle contraction force and muscle wet weight did not differ significantly between groups in which nerves were repaired within four weeks of severance. These results indicate that peripheral nerve repair within four weeks of severance does not influence the muscle contraction force of single muscle despite the misdirection of motor axons toward the distal sensory Schwann tubes.     

Intercostal nerve cross-anastomosis and DREZ-tomy in a patient with brachial plexus avulsion

An 18-year-old male with a right brachial plexus injury caused by a motorcycle accident was admitted on October 13, 1988. A detailed examination revealed that the brachial plexus was totally injured. The axon reflex test suggested that the lesion sites were postganglionic in the C5 and C6 nerves, and preganglionic in the C7, C8 and Th1. On December 14, 1988, intercostal nerve cross-anastomosis was performed in the hope that a lost motor function of the right upper extremity could be restored as a first step. An electromyogram 6 months after this anastomotic operation demonstrated synkinesis between the biceps brachialis and the intercostal muscles during deep inspiration. Fifteen months after this operation, active voluntary muscle discharges which were higher than before in amplitude, were provoked. The right elbow flexion was gradually restored independently of respiration. On the other hand, intractable pain with a persistent severe tingling sensation appeared approximately one week after the injury on the lesioned upper extremity. The pain rapidly increased in severity. The DREZ-tomy from C5 to Th1 was performed on March 7, 1989. This has brought complete relief of the intractable pain. A brief discussion was given concerning some aspects of the brachial plexus avulsion and DREZ-tomy.     

陈旧性神经损伤后雪旺细胞的变化实验研究

目的 观察大鼠坐骨神经损伤后雪旺细胞的变化。方法 切断成年SD大鼠右侧坐骨神经，形成10mm缺损。于术后1～12个月不同时间段取材。标本用p75受体（p75 neurotrophin receptor．p75NTR）、S-100免疫荧光染色，激光共聚焦显微镜观察，另部分标本进行超微结构观察。结果 神经损伤后1个月，损伤远端神经中p75NTR和S-100的表达最多，在损伤后6个月时p75NTR降至正常水平，S-100则在损伤后9个月时消失。电镜下，雪旺细胞出现在神经内膜管内，神经内膜管下及内膜管周围有大量胶原原纤维增生。结论 大鼠坐骨神经损伤后，雪旺细胞中p75NTR的表达增加，但随损伤时间的延长呈进行性下降，伤后6个月时消失。     

Comparison of the neurotropic effects of motor and sensory Schwann cells during regeneration of peripheral nerves.

We examined the inductive ability of motor and sensory Schwann cells on regeneration of motor and sensory axons using a silastic Y chamber, and Lewis rats L5 ventral root (motor) and saphenous nerve (sensory). We developed four experimental models: motor-motor nerve group-proximal motor stump with distal fresh and frozen/thawed motor nerve segments (n = 7); sensory-sensory nerve group-proximal sensory stump with distal fresh and frozen/thawed sensory nerve segments (n = 7); motor-sensory nerve group-proximal motor stump with distal fresh and frozen/thawed sensory segments (n = 8); and sensory-motor nerve group-proximal sensory stump with distal fresh and frozen/thawed motor segments (n = 8). The gap was set at 4 mm. Six weeks postoperatively we compared the number of regenerated myelinated axons in the two distal channels, and found that sensory Schwann cells have a strong inductive ability for regeneration of both sensory and motor axons. Motor Schwann cells have weak inductive ability for regeneration of motor axons and no inductive ability for regeneration of sensory axons.     

Experimental investigation of cross-nerve transfers relating to repair of brachial plexus avulsion injuries

There is a lack of agreement regarding the potential for peripheral nerve cells with short axons to regenerate and innervate the terminal end organs of nerve cells with long axons. We designed a study to evaluate experimentally the possibility of neurons to reconstitute much longer axonal segments. Twenty Wistar rats were used. The brachial plexus was isolated and the radial nerve transected immediately after its origin. The proximal end of the axillary nerve (previously cut) then was coapted tot he distal stump of the radial nerve. In 10 other rats, the cut radial nerve was simply recoapted to itself without involvement of the axillary nerve; these animals served as controls. Finally, in 10 rats, nerves were cut without repair to evaluate the degenerative changes. After 90 days, the distal part of the radial nerve was examined by light microscopy, calculating the number and area of regenerated axons. We also checked the motor end-plates of reinnervated muscles. In the nerve-transferred group, good axonal regeneration with good reinnervation of the muscles was seen. In this way, we have experimentally demonstrated a plasticity of regeneration in peripheral nerves. This suggests that the surgeon may use nerves connected to proximal muscles to neurotize avulsed nerves of distal muscles.     

Inside-out versus standard artery graft to repair a sensory nerve in rats

It is known that a vein graft provides a good microenvironment for axon regeneration in motor peripheral nerves, but the use of artery graft for regeneration of sensory nerves is controversial. We sectioned the saphenous nerve and repaired it by using heterologous inside-out and standard artery graft techniques in rats. After 4, 12, and 20 weeks, the graft and the distal stump were observed under electron microscopy. In each period studied, the pattern, diameters, and thickness of the myelin sheaths of the regenerated axons were measured in the graft and distal stump. There was capillary invasion in both the graft and distal stump, especially in the inside-out artery graft group. Regenerated nerve fibers were prominent in both heterologous artery grafts 4 weeks after the surgical procedures. Conversely, in the distal stump, regenerated nerve fibers were observed only after 12 weeks. In both the inside-out artery graft and standard artery graft, no statistical difference in the diameters and thickness of the myelinated fibers after 20 weeks was observed.