周围神经挤压伤后纤溶成分表达的变化

目的 观察大鼠坐骨神经挤压伤后纤溶成分中组织型纤溶酶原激活剂（ｔ－ＰＡ）和纤溶酶原激活剂抑制因子１（ＰＡＩ－１）蛋白表达的变化,了解ｔ－ＰＡ、ＰＡＩ－１在周围神地操作后修复过程中的作用。方法 取２１只Ｗｉｓｔａｒ大鼠,分别造成坐骨神经挤压伤模型。在术后６ｈ、１ｄ、３ｄ、７ｄ、１４和２１ｄ分别取材进行组织学、免疫组化观察。结果 术后３ｄ时神经断端回缩球处的ｔ－ＰＡ抗原呈阳性反应。７ｄ时损伤进行组织学     

碱性成纤维细胞生长因子在周围神经损伤局部的基因表达与细胞 …

目的 观察碱性成纤维细胞生长因子（ｂａｓｉｃ ｆｉｂｒｏｂｌａｓｔ ｆａｃｔｏｒ,ｂＦＧＦ）ｍＲＮＡ在周围神经损伤后的局部表达规律及细胞定位。方法 ６０只Ｗｉｓｔａｒ大鼠随机分为正常组（４只）、对照组和实验组（各２８只）。用改良持针器钳夹大鼠坐骨神经制成神经挤压伤模型,分别于术后４ｈ、１、３、７、１４、２１、２８ｄ处死大鼠,切取包括挤压伤及其上下各２ｍｍ的神经段,应用引物原位标记技术（ｐｒｉｍｅｄ     

睫状神经营养因子对周围神经损伤后再生的影响

目的 研究睫状神经营养因子（ＣＮＴＦ）对周转神经损伤后再生的影响。方法 用硅胶管桥接大鼠双侧坐骨神经缺损,形成神经再生室。左侧室内注入基因重组人ＣＮＴＦ,右侧注入生理盐水（ＮＳ）。术后１４、３０、６０和９０天取材,行大体、光镜、电镜观察。术后９０天行轴突图像分析、电生理检测及霍乱毒素－辣根过氧化物酶（ＣＢ－ＨＲＰ）逆行追踪。结果 与对照侧相比,实验侧再生有髓神经纤维数目较多、轴突较粗且髓鞘较厚,复合肌肉动作电位（ＣＭＡＰ）的潜伏期较短、神经传导速度较快且波幅较高。实验侧ＣＢ－ＨＲＰ标记的脊髓前角运动细胞数明显多于对照侧。结论 外源性ｈＣＮＴＦ有明显促进周围神经再生作用。     

血清源酸热稳定多肽促伤口愈合的研究

为了研究多肽促进伤口愈合的可能性，从猪血清中分离出一组酸、热稳定的多肽，分子量低于１８ｋｕ，无免疫原性、无毒副作用。用５０μｌ多肽制剂（５ｍｇ／ｍｌ）注入小鼠皮下埋置的聚乙烯醇海绵“死腔伤口”中，从致伤当日起，每日一次共５次；对照“死腔伤口”内注入５０μｌ牛血清白蛋白（５ｍｇ／ｍｌ）。伤后７，１０ｄ治疗组海绵中总ＤＮＡ、蛋白质及羟脯氨酸含量明显高于对照组，有显著差异（Ｐ＜０．０５），伤后１４ｄ两组间无差异（Ｐ＞０．０５）。体外实验发现，与对照基质１％胎牛血清１６４０液相比，含０．２％多肽制剂的对照基质可明显促进伤口修复细胞增殖，经统计学处理有显著差异（Ｐ＜０．０５）。结果证实，猪血清源分子量低于１８ｋｕ的酸、热稳定多肽，具有促伤口愈合的活性，直接促进伤口修复细胞生长是其发挥作用的机理之一。     

肿瘤坏死因子对周围神经损伤后脊髓前角运动神经元 …

目的 探讨肿瘤坏死因子－α（ＴＮＦ－α）对周围神经损伤后的脊髓前角运动神经元胞体的保护作用。方法 Ｗｉｓｔａｒ大鼠２０只,随机分为实验组与对照组,每组１０只。切断灰侧坐骨神经、近端套入硅胶管内,管内分别注入生理盐水（ＮＳ）、ＴＮＦ－α（３０Ｕ／ｍｌ）各１６μｌ。术后２周,取腰４、５脊髓,行乙酰胆碱酯酶（ＡＣｈＥ）、一氧化氮合酶（ＮＯＳ）染色。应用计算机图像分析系统计算出脊髓前角运动神经元ＡＣｈＥ、     

体外冲击波碎石对兔肾血流量影响的研究

采用放射性生物微球（Ｃｒ＾５１－蟾蜍红细胞）技术测定兔左肾接受体外冲击波碎石术（ＥＳＷＬ）处理后不同时期的双肾皮、髓质血流量。２５只兔随机分为５组，１组作为对照组，另４组兔左肾均接受ＥＳＷＬ处理。结果显示，术侧肾皮质血流量从术后第３ｄ开始减少，第７ｄ减少有显著性差异（Ｐ〈０．０５），第１４ｄ仍低于对照组；术侧肾髓质血流量先增加，第７ｄ减少，第１４ｄ减少有显著性差异（Ｐ〈０．０５）；采用自身对照，未     

抗癌药物对乳腺癌细胞动力学及凋亡基因Bc1-2/Bax的影响

探讨抗癌药物对乳腺癌细胞动力学及凋亡基因Ｂｃｌ－２／Ｂａｘ的影响。方法用流式细胞术测定乳腺癌细胞核ＤＮＡ含量（ＤＩ）、Ｓ期细胞比率（ＳＰＦ）、细胞凋亡指数（ＡＩ）、凋亡基因Ｂｃｌ－２、Ｂａｘ的表达及雌激素受体（ＥＲ）等进行定量分析。结果①用药组与对照组相比,ＤＩ、ＳＰＦ及Ｂａｘ明显低于对照组（Ｐ＜０．０１）,而ＡＩ（Ｐ＜０．０５）、Ｂｃｌ－２（Ｐ＜０．００１）则高于对照组,ＥＲ于两组间无统计学差异;②ＡＩ与ＳＰＦ、Ｂｃｌ－２及ＥＲ的表达均呈正相关,而与Ｂａｘ无明显相关关系。结论抗癌药物主要通过细胞凋亡而发挥作用,用药后的生物学指标可表现为ＡＩ及Ｂｃｌ－２升高,ＳＰＦ、ＤＩ值及Ｂａｘ下降;ＡＩ与ＳＰＦ、Ｂｃｌ－２及ＥＲ均呈正相关。根据这些指标可判定药物的疗效,并可用于预后的预测。     

三磷酸腺苷氯化镁对兔缺血后肝组织保护作用的研究

家兔全肝缺血３０分钟后，分别给予生理盐水、三磷酸腺苷（ＡＴＰ）和三磷酸腺苷氯化镁（ＡＴＰ－ＭｇＣｌ２），术后第１，３，５天取血测定谷丙转氨酶（ＡＬＴ）、乳酸脱氢酶（ＬＤＨ）和碱性磷酸酶（ＡＬＰ）。术后第１天ＡＴＰ－ＭｇＣｌ２组ＡＬＴ明显低于对照组（Ｐ＜０．０５），而ＡＴＰ组与对照组相比无显著差别；ＡＴＰ－ＭｇＣｌ２及ＡＴＰ组的ＬＤＨ和ＡＬＰ与对照组相比无显著差别。术后２４小时超微结构示：对照组肝明显水肿、细胞器严重损伤和血窦内微小血栓；而ＡＴＰ－ＭｇＣｌ２组细胞轻度水肿，细胞器基本正常，血窦内无微小血栓。实验结果说明ＡＴＰ－ＭｇＣｌ２对缺血肝组织确有保护作用，其机制可能是通过改善微循环和减轻细胞而起作用的     

损伤大鼠坐骨神经诱导运动神经元凋亡的初步报告

目的探索成年大鼠坐骨神经高位损伤后是否出现运动神经元细胞的凋亡。方法取鼠龄为５～６周的成年雄性ＳＤ大鼠２４只,体重１２０～１５０ｇ。大鼠分组：（１）正常对照组,６只大鼠;（２）实验组：１８只大鼠。高位切断并结扎其坐骨神经,按手术先后随机分成术后５、１４、２１天３个不同时间组。按术后不同时间处死动物。用４％多聚甲醛经心脏灌注后,切取Ｌ４～６节段腰髓,制成石蜡切片。采用原位末端脱氧核糖核苷酸转移酶介导的ｄＵＤＰ标记法标记凋亡的神经元。结果对照组未出现阳性标记的细胞。神经损伤后第５天有１只大鼠伤侧前角出现３个阳性标记的凋亡运动神经元。伤后第１４天、２１天出现凋亡神经元的数目分别为２．２±１．２及５．２±２．３个（ｘ±ｓｘ,下同）。结论当成年大鼠坐骨神经切断并被结扎后,由于阻断了神经营养因子的逆行运输,可以导致运动神经元的凋亡。     

血小板活化因子及其受体拮抗剂对脊髓损伤后脊髓血流量的影响

实验采用鞘内注射血小板活化因子（ＰＡＦ）及静脉注射ＰＡＦ受体拮抗剂ＢＮ５２０２１，观察其对猫脊髓损伤后伤区和邻近脊髓（Ｌ２－Ｌ４）血流量及血浆血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺１α（６－ｋｅｔｏ－ＰＧＦ１α）比值（Ｔ／Ｋ值）的影响。     

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.     

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.     

Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve

In this paper the recovery after repair of the median nerve has been used to compare different assessment tools for evaluation of peripheral nerve function: touch (moving 2-point discrimination (2PD); Semmes-Weinstein (SW) monofilament, motor (Medical Research Council (MRC) scale), combined motor and sensory (Dellon modification of the Moberg pick up test; Moberg Recognition test), and pain (visual analogue scale; pinprick-test). The mean (SD) age of our 28 patients was 28 (12) years. The mean (SD) follow-up period was 5 years, 2 months (2 years, 8 months). On the operated side three patients (11%) had a moving 2PD of less than 4 mm. The results of the moving 2PD were compared with those of the SW monofilaments, but with a poor correlation. The MRC score correlated well with opposition movement of the thumb and muscle wasting (p<0.01). We recommend a number of tests to evaluate (the chronological return of) peripheral nerve function.     

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.     

Indication,technique and results of facial nerve reconstruction

Summary 160 patients with various intraor extracranial pathologies were treated by microsurgical facial nerve reconstruction at Nordstadt Neurosurgical Clinic between 1978 and 1993. Facial nerve reconstruction was accomplished along the anatomical course of the facial nerve from its origin at the brainstem, within the mastoid, at the stylomastoid foramen and within the face. Mostly, reconstruction was indicated because of nerve discontinuity (n=61), whereas facial nerve reanimation with a donor nerve such as the contralateral facial nerve or the ipsilateral hypoglossal nerve was indicated in 99 cases of loss of a proximal nerve stump. Depending on the site of the lesion reinnervation started at 5 to 15 months postoperatively lasting for 2 to 3 years with overall satisfactory results. 69% of all the patients regained good symmetry on rest, complete eye closure equivalent to House-Brackmann-Score III: Patients with complete failures either suffered of non-related diseases such as cancer leading to death before the estimated time of recovery or were exposed to radiation or received facial nerve reconstruction after long-standing facial deficit and marked muscular atrophy. The indication of the adequate method depends on the clinical course with or without preexisting facial paresis, on considering the intraoperative state of the facial nerve, the identification and microsurgical preparation of adequate nerve stumps, as well as on the adaptation techniques and the postoperative guidance of the patient. We conclude that facial nerve reconstruction by transplantation at either site of the nerve course or by reanimation with a donor nerve are effective and reliable procedures of treatment leading to satisfactory functional and cosmetic results.     

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.     

Anatomie fonctionnelle du nerf trijumeau

The cranial nerve (CN) V is a mixed nerve that consists primarily of sensory neurons. It exits the brain on the lateral surface of the pons, entering the trigeminal ganglion within a few millimeters. Three major branches emerge from the trigeminal ganglion. The first division (V1, the ophthalmic nerve) exits the cranium through the superior orbital fissure, entering the orbit to innervate the globe and skin in the area above the eye and forehead. The second division (V2, the maxillary nerve) exits through a round hole, the foramen rotundum, into a space posterior to the orbit, the pterygopalatine fossa. It then re-enters a canal running inferior to the orbit, the infraorbital canal, and exits through a small hole, the infraorbital foramen, to innervate the skin below the eye and above the mouth. The third division (V3, the mandibular nerve) exits the cranium through an oval hole, the foramen ovale. The third division also has an additional motor component, which may run in a separate fascial compartment. Most fibers travel directly to their target tissues. Sensory axons innervate skin on the lateral side of the head, the tongue, and the mucosal wall of the oral cavity. Motor fibers innervate the muscles that are attached to the mandible. Some sensory axons enter in the mandible to innervate the teeth and emerge from the mental foramen to innervate the skin of the lower jaw.     

双神经卡压综合征

目的：研究双神经卡压征的病因及手术治疗方法。方法：分析了自１９８８年以来同时诊断为腕管综合征和肘管综合征２６例３４侧的临床资料。全部患者均作两处神经松解术，平均随访１７个月。疗效评定标准，根据术后症状、体征的改善程度分优、良、可和无效四级。结果：２５侧术后疗效优良，占７３．６％（２５／３４）。结论：双神经卡压征手术治疗效果较好。当双神经卡压同时合并颈部神经卡压时，建议优先考虑远端的神经减压。当远端神经减压后未能改善近端神经卡压症状时，才考虑近端神经减压