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A single fourth lumbar dorsal rootlet was transected at the entry point into the spinal cord. The nerve fibres were labelled with biotin dextran injected into the rootlet. An endogenous matrix containing olfactory-ensheathing cells (OECs) labelled with green fluorescent protein was applied to the opposing cut surfaces of the rootlet and the spinal cord, which were then brought into apposition and held in place by fibrin glue. Two weeks later, a ladderlike bridging structure has been formed by astrocytic processes growing out for about 200-300 microm from the spinal cord. The transplanted cells remained largely confined to this area. They were elongated along the nerve axis but did not enter the spinal cord itself. Labelled dorsal root axons crossed the repaired dorsal root entry zone in alignment with the bridging astrocytic processes and the transplanted cells and then proceeded beyond the transplant to enter the grey matter of the dorsal horn and send axons both rostrally and caudally for at least 10 mm in the white matter of the ascending dorsal columns.  相似文献
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脊髓背根入髓区毁损术治疗臂丛神经撕脱伤后疼痛   总被引:1,自引:0,他引:1  
目的 探讨脊髓背根入髓区毁损术治疗臂丛神经撕脱伤后疼痛的疗效及安全性.方法 15例臂丛神经撕脱伤后疼痛患者接受脊髓背根入髓区毁损术治疗.分别于术后2周、6个月和1年采用视觉模拟评分(VAS)、汉密尔顿抑郁(HAMD)和焦虑评分(HAMA)来评估手术疗效.结果 手术早期,100%的患者疗效满意,经过1年的随访,疗效满意率逐渐下降.但是比较术后2周和术后6个月,以及比较术后2周和术后1年的VAS评分,结果 显示无统计学差异.并发症主要包括同侧下肢的轻度无力(3例)和同侧下肢深感觉障碍(3例),在术后6个月都有不同程度的恢复.结论 脊髓背根入髓区毁损术是治疗臂丛神经撕脱伤后疼痛的一种安全、有效的措施.  相似文献
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脊髓背根入髓区毁损术治疗脊髓和马尾神经损伤后疼痛   总被引:1,自引:0,他引:1  
目的 探讨脊髓和马尾神经损伤后疼痛的神经外科治疗方法、效果和安全性.方法 脊髓和马尾神经损伤后疼痛患者14例,年龄28~72岁,病程8个月-28年;疼痛位于下肢感觉减退和缺失区,为烧灼、压榨或痉挛样疼痛,视觉模拟疼痛评分(Visual analogy scale,VAS)8~10分;均伴有不同程度的下肢肌力下降.14例患者共行脊髓背根入髓区(dorsal root entry zone,DREZ)毁损术15次.结果 随访3个月-3年.6例疼痛消失,5例疼痛明显减轻,停用或少量使用镇痛剂,VAS 2~4分;3例疼痛无明显改善.所有病例无严重手术并发症.结论 DREZ毁损术对脊髓和马尾神经损伤后慢性神经病理性疼痛安全有效.  相似文献
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Somatic and visceral sensory information enters the central nervous system (CNS) via root entry zones where sensory axons span an environment consisting of Schwann cells in the peripheral nervous system (PNS) and astrocytes and oligodendrocytes in the CNS. While the embryonic extension of these sensory axons into the CNS has been well-characterized, little is known about the subsequent, largely postnatal development of the glial elements of the root entry zones. Here we sought to establish a comparative developmental timecourse of the glial elements in the postnatal (P0, P3, P7, P14) and adult rat of three root entry zones: the spinal nerve dorsal root entry zone, the trigeminal root entry zone, and the vagal dorsal root entry zone. We compared entry zone development based on the expression of antigens known to be expressed in astrocytes, oligodendrocytes, oligodendrocyte precursor cells, Schwann cells, radial glial fibres and the PNS extracellular matrix. These studies revealed an unexpected distribution among glial cells of several antigens. In particular, antibodies used to label mature oligodendrocytes (RIP) transiently labelled immature Schwann cell cytoplasm, and a radial glial antigen (recognized by the 3CB2 antibody) initially decreased, and then increased in postnatal astrocytes. While all three root entry zones had reached morphological and antigenic maturity by P14, the glial elements comprising the PNS–CNS interface of cranial root entry zones (the trigeminal root entry zone and the vagal dorsal root entry zone) matured earlier than those of the spinal nerve dorsal root entry zone.  相似文献
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Three patients who, following partial brachial plexus avulsion, experienced pain, involuntary finger twitching and muscular spasms are reported. Two exhibited cutaneous trigger zones, stimulation of which exacerbated their pain; changes in emotional tone aggravated both the pain and the spasms. Pain would appear to be due not only to deafferentation and scarring of the dorsal horn, but also to an afferent pathological barrage from partially damaged dorsal roots. The pathological sensory barrage may activate metameric interneuronal circuits and produce involuntary movements. Exacerbation of both the pain and the spasms can be explained on the basis of intrinsic properties of these ectopic pacemakers.  相似文献
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目的探讨脊髓背根入髓区(dorsal not entry zone,DREZ)显微外科毁损术对脊髓和马尾神经损伤后神经病理性疼痛的长期疗效和安全性。方法脊髓和马尾神经损伤后神经病理性疼痛35例,均行DREZ显微外科毁损术。对所有病人进行术前和术后视觉模拟疼痛评分(VAS),以术后疼痛缓解〉75%为疗效优秀,疼痛缓解50%~75%为良好,疼痛缓解〈50%为差。结果术后2周疗效优秀33例(94.3%),疗效差2例(5.7%)。长期随访中,疗效优秀24例(68.6%),疗效良好6例(17.1%),疗效差5例(14.3%)。结论DREZ显微外科毁损术对脊髓和马尾神经损伤后神经病理性疼痛长期疗效满意,并发症少,可明显提高病人的生活质量。  相似文献
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目的 研究脊髓后根入髓区(DREZ)切开术治疗臂丛神经根撕脱后疼痛的临床应用.方法 本组58例,男53例,女5例,年龄30~71岁.左侧35例,右侧23例,疼痛病程6个月- 50年.术前经镇痛药物及多种止痛手术治疗均无效.结果 患者均在全麻下行DREZ切开术治疗,术后6个月、12个月和超过24个月的止痛疗效良好和优秀的比例分别为87.9%、84.5%和80.0%.无严重并发症出现.结论 DREZ切开术能够有效消除臂丛神经根撕脱后疼痛,疗效确切,效果持久,安全性较高.  相似文献
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目的 探讨脊髓和马尾神经损伤后慢性神经源性疼痛的神经外科治疗策略.方法 脊髓和马尾神经损伤后慢性神经源性疼痛20例,年龄28~81岁,病程8个月~50年.共行镇痛手术23次,其中,脊髓背根入髓区显微外科切开术19次,脊髓电刺激术3次,鞘内靶控输注系统植入术1次.采用视觉模拟评分(VAS)来评估手术疗效,以术后疼痛缓解大于75%为疗效优秀,疼痛缓解50%~75%为良好,疼痛缓解小于50%为差.结果 随访6个月~4年,10例疼痛消失,停用镇痛剂,生活质量改善;7例疼痛明显减轻,VAS 2~4分,其中,5例停用镇痛剂,2例镇痛剂使用量明显下降,生活质量改善;3例疼痛无明显改善.结论 脊髓背根入髓区显微外科切开术和脊髓电刺激术对脊髓和马尾神经损伤后慢性神经源性疼痛患者疗效满意,但其适应证有差别,应根据患者的损伤节段、损伤程度和疼痛部位等具体情况选择手术方式.  相似文献
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