沈氏经椎弓根内固定装置治疗胸腰段脊柱脊髓损伤

本组使用沈氏经椎弓根内固定装置共治疗胸腰段脊柱损伤１０４例。其中男８２例，女２２例。年龄１６～６８岁，平均３８岁。伴有脊髓神经损伤７３例（７０．２％）。随访时间６～５４个月，平均２６个月。治疗结果，后凸畸形角由术前２７．６°矫正到术后４．４°，矢状面水平位移由术前３１．２％纠正到术后０％，压缩椎体高度由术前的５２．９％恢复到术后的９６．４％。椎管矢状径和面积分别由术前的１１ｍｍ和１．２ｃｍ２恢复到术后的１４．４ｍｍ和１．８ｃｍ２（Ｐ＜０．０５）。不完全截瘫组术后神经功能有Ｆｒａｎｋｅｌ一级以上改善的为９０．６％。临床疗效表明沈氏装置是胸腰段脊柱损伤可选择的良好内固定之一。     

额颞上提矫正眉下垂

目的：对已明确的眉部下垂为特征的病例，施行额颞上提矫正手术。观察临床效果。方法：对２７例确诊者行两侧颞顶部弧形切口的眉上提手术，使颞额部向外上方提拉。结果：术后１０天～１４天的眉部平均高度；内中由１８．４ｍｍ升至２１．２ｍｍ，瞳孔中点由１７．３ｍｍ升至２３．７ｍｍ，外中由１７．２ｍｍ升至２９．４ｍｍ，所有病例经过顺利，效果满意。结论：对以眉下垂为主要改变的睑皮肤松垂病例采用颞额上提矫正手术可获得良好效果。     

周围神经端侧吻合后神经再生的研究

目的研究周围神经端侧吻合后远端神经的再生及其临床应用价值。方法选用３７只Ｗｉｓｔａｒ大鼠，分成Ａ、Ｂ两组。Ａ组：切断腓神经，在邻近的胫神经干外膜上开一１ｍｍ小窗，将腓神经远端吻合到胫神经干侧方开窗处。Ｂ组：切断腓神经后，在胫神经干和远侧腓神经干外膜上各开一小窗，取对侧相应的腓神经以端侧吻合的方式桥接于胫、腓神经干两窗之间。两组分别于术后４、８、１２周取材，作神经组织学、电镜及图像分析仪检测：（１）神经再生的数量和质量；（２）定性定量观察神经再生情况；（３）再生神经的数目、密度及截面积。结果直接端侧吻合或神经桥接移植的端侧吻合，均可使神经再生，且再生纤维的质量与端端吻合组（对照组）无显著性差异（Ｐ＞０．０５）；对被吻合神经－胫神经的功能亦无影响。结论神经端侧吻合可作为神经损伤后一种新的修复方法     

重组人表皮生长因子对皮片体外培养生长的影响

为探讨不同浓度重组人表皮生长因子（ｒｈＥＧＦ）对成人皮片体外培养生长的影响。采用约２ｍｍ２的皮片接种到２４孔培养板内加入不同浓度的ｒｈＥＧＦ培养４天，测量皮片生长面积。结果表明：ｒｈＥＧＦ对皮片生长有明显的调控作用，皮片生长面积与ｒｈＥＧＦ浓度呈抛物线型相关，当浓度为５μｇ／Ｌ时，皮片生长面积达到最大值７．０８±２．４０ｍｍ２，约为对照组（３．６４±１．９８ｍｍ２）的２倍。提示ｒｈＥＧＦ在促进皮肤快速生长方面有潜在的临床应用价值。     

左右冠状动脉右室瘘1例

病儿男,４岁。生后４０天发现心脏杂音。查体：胸骨左缘第３、４肋间可闻及２～３／ＶＩ级全收缩期杂音,Ｐ２亢进、分裂。心电图示窦性心律。Ｘ线胸片示肺动脉段饱满,肺血增多,心胸比率０．５１。多普勒超声心动图示左房、右室增大,肌部室间隔中断８．３ｍｍ×５．１...     

臂丛神经手术并发症的防治

自１９８２年至１９９５年。共手术治疗臂丛神经损伤５５例，术后发生并发症２例，发生率为３．６４％（２／５５）。现就其发生原因及防治方法谈一点看法。例１男，２０岁，因摩托来车祸致左臂丛神经损伤。入院后局部检查发现：耸肩正常，肩关节被动活动正常，主动不能；斜方肌肌力４度，胸大肌肌力４度，肱三头肌肌力４度，腕伸肌肌力３度，指伸肌与拇长伸肌肌力２度。Ｇ５～７支配的其它肌肉肌力均为０度。诊断：Ｃ５－７神经根性撕脱伤。于伤后３个月手术，行膈神经移位加腓肠神经移植，接肌皮神经；副神经移位接腋神经。术后第２天发现…     

几丁质桥接周围神经缺损的实验研究及临床应用

本文采用经酸碱处理提纯的精制蚕蛹壳几丁质，不含蛋白质，杂质，肽类及水分，用特殊工艺制成的可吸收性的生物管道，作为神经再生室，桥接大鼠坐骨神经缺损．实验选用体重２５０～３００ｇＷｉｓ－ｔａｒ大鼠，实验组２０只，以骨骼肌桥接作为对照组１０只．术后４，８，１２周进行显微解剖观察，神经电生理测定，组织学检查和ＨＲＰ（辣根过氧化酶）逆行示踪法鉴定．结果显示：神经电生理测定术后８周几丁质桥接组测到大鼠腿部肌肉收缩并记录到微弱的电信号波形，组织学检查发现术后４周几丁质桥接近端再生神经纤维已长入到远端；对实验组术后８周进行ＨＲＰ逆行示踪，结果在脊髓腰膨大段灰质前角均见到ＨＲＰ标记的运动神经元，其细胞主要集中在Ｌ５，６和Ｓ１节段．本文临床应用４例，尺神经损伤３例，桡神经浅支损伤１例，经６～１８个月随访，取得了满意效果．     

尿道会师牵引术加硅胶管持续尿道扩张治疗后尿道断裂

目的 提高骨盆骨折后尿道断裂手术治疗效果。方法 对５２例骨盆折后尿道断裂患者行尿道会师牵引，术后１２～１４天，尿道内置入三根直径２．４～３．０ｍｍ硅胶管，持续尿道扩张３个月。结果 ５２例患者治愈５０例，治愈率９６％，良好２例，良好率４％。结论 此术式简便易行，安全有效，可显著降低尿道感染及狭窄的发生。     

咪唑安定对体感诱发电位的影响

目的：了解咪唑安定对体感诱发电位的影响。方法：选择３０例ＡＳＡＩ～Ⅱ级的脑外科手术病人，根据国际１０～２０系统，在Ｃ３或Ｃ４、ＦＰｚ（参考）和ＳＣ（第二颈椎棘突处）安放盘状记录电极，记录体感诱发电位。均分为三组按剂量（０．２ｍｇ／ｋｇ、０．３ｍｇ／ｋｇ和０．４ｍｇ／ｋｇ）静脉注射咪唑安定，连续观察皮层Ｎ２０、Ｐ２３和颈髓Ｎ１４电位的变化。结果：（１）用药后，皮层Ｎ２０和颈髓Ｎ１４电位的波幅降低，分别抑制到术前的６３．７５％和４８．７５％（Ｐ＜０．０５），苏醒后恢复到基础水平；（２）颈髓Ｎ１４、皮层Ｎ２０和Ｐ２３的潜伏期及中枢传导时间均无显著延长，（３）各剂量组间的ＳＥＰ变化无明显差别。结论：咪唑安定对ＳＥＰ一定程度的抑制作用临床意义不足，可用作ＳＥＰ监测时的静脉麻醉药。     

氧化亚氮对安氟醚脑电功率谱的影响

２０例择期手术患者，随机分成安氟醚（Ｅｎｆ）组和安氟醚加氧化亚氮（Ｅｎｆ／Ｎ２Ｏ）组，每组１０例。静脉硫喷妥钠５ｍｇ／ｋｇ、阿曲库铵０．６￣０．７ｍｇ／ｋｇ诱导后气管内插管，机械通气维持ＰｅｔＣＯ２４．２７￣４．９３ｋＰａ。间断静脉注射阿曲库铵１０￣１５ｍｇ，维持Ｔ４／Ｔ３〈２５％，ＳｐＯ２≥９９％，采用ＦＰ１－Ａ１、ＦＰ２－Ａ２双导联脑电监测，记录原始脑电以观察脑电功率谱和９５％边缘频率（ＳＥＦ     

Pre-degenerated nerve shows enhanced regeneration after incremental elongation in rats.

Following nerve degeneration, we investigated effects of linear elongation on subsequent nerve regeneration in a total of 92 Wistar rats (weight 380-430 g). The nerve was ligated at the midthigh and then elongated incrementally by a total of 15 mm by leg lengthening at a rate of 3 or 5 mm/day. Seven days after initiation of nerve elongation, the external fixator was removed and normal leg length was restored with internal fixation. Then a 10 mm nerve segment at the ligature site was excised, and the nerve was repaired with sutures (group D). At 2, 4, 6, and 8 weeks after nerve suturing, we examined transverse semi-thin nerve sections compared with group I (severed and repaired after leg lengthening without a nerve ligature) and control group (severed and repaired without leg lengthening). After lengthening at 3 mm/day, nerve regeneration in group D was enhanced at 4 weeks. After lengthening at 5 mm/day, nerve regeneration in group D also was enhanced at 6 and 8 weeks. Pre-degenerated nerve showed better regeneration after suturing than intact nerve. Elongation holds promise as an alternative to nerve grafting in treatment of nerve injury.     

Effect of the rate of prestretching a peripheral nerve on regeneration potential after transection and repair

We tested the influence of nerve stretch injury on nerve regeneration after cutting and suturing. An external fixator was used to lengthen the femur, and consequently the sciatic nerve, progressively, by 3mm/day (5%/day: group I) or 5mm/day (9%/day: group II). In both groups the total lengthening was 15mm, corresponding to approximately 23%–28% elongation of the sciatic nerve. Seven days after initiating nerve lengthening, the external fixator was removed and the nerve was transected and sutured. At 2, 4, 6, or 8 weeks after this suturing, semithin sections were prepared from the sciatic and tibial nerves. Although regeneration of nerve fibers was observed beginning at 2 weeks in all groups, nerve regeneration showed a delay only in group II at 6 weeks, when group I showed nerve regeneration as good as in the unstretched control group. Differences in nerve regeneration after nerve lengthening at different rates were considered the result of mechanical nerve injury, nerve degeneration, ischemia, and fibrosis, all made worse with more rapid lengthening. Nerve lengthening at a more moderate rate (3mm/day) did not appear to compromise regeneration.     

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.     

Chitooligosaccharides promote peripheral nerve regeneration in a rabbit common peroneal nerve crush injury model

Chitooligosaccharides (COSs) are the biodegradation products of chitosan that have been demonstrated with neuroaffinity and/or neuroprotective actions. In this study, we investigated the possible benefits of treatment with COSs on nerve regeneration after crush injuries to peripheral nerves. The rabbits with the crushed common peroneal nerve were treated by daily intravenous injection of 1.5 or 3 mg/kg body weight of COSs or identical volume of saline (as the control) for a 6‐week period. At the end of COSs treatment, electrophysiological assessments, Meyer's trichrome and Masson trichrome staining, and transmission electron microscopy were used to evaluate the regeneration of injured common peroneal nerve and atrophy of the tibialis posterior muscle. The results showed that the compound muscle action potentials, the number of regenerated myelinated nerve fibers, the thickness of regenerated myelin sheaths, and the cross‐sectional area of tibialis posterior muscle fibers were significantly improved in the nerves that received COSs treatment and the results with COSs treatment displayed a dose‐dependent pattern. This study demonstrated that COSs accelerated peripheral nerve regeneration after crush injury to rabbit common peroneal nerves. The COSs could probably become a potential neuroprotective agent for improvement of peripheral nerve regeneration after the injury and deserve for further studies. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.     

Erythropoietin promotes the recovery of erectile function following cavernous nerve injury

PURPOSE: We investigated the effects of recombinant human (rh) erythropoietin (EPO) on erectile function recovery in a rat model of cavernous nerve (CN) injury. MATERIALS AND METHODS: Male rats underwent unilateral CN transection and excision of a 5 mm segment of the contralateral CN. One group received rhEPO (5,000 U/kg) subcutaneously daily for 14 days, while another received rhEPO 1 day and 1 hour prior to nerve injury. An additional group of animals was pretreated with 1 dose of darbepoetin (25 microg/kg). At 14 days following CN injury rats underwent erection physiology studies. Axonal regeneration was evaluated by electron microscopy. EPO receptor expression in the penis and major pelvic ganglion was evaluated immunohistochemically and by real-time polymerase chain reaction. RESULTS: Daily rhEPO effectively recovered erections after CN injury compared with saline treatment. Maximal intracavernous pressure area under the curve normalized to mean arterial pressure was significantly greater in EPO treated vs saline treated animals (p < 0.05). rhEPO and darbepoetin pretreatment was as effective as continuous 14-day therapy. EPO receptor expression was localized to neuronal cell bodies of the major pelvic ganglion, penile nerves and endothelial cells in the penis. Electron microscopy revealed significant improvement in axonal regeneration in rhEPO treated animals 14 days following injury compared to controls. CONCLUSIONS: EPO receptors are expressed in local neuronal and vascular tissues. Exogenous administration of rhEPO or darbepoetin in the setting of CN injury promotes erectile function recovery. This occurs through axonal regeneration of the injured nerve and possible penile protection.     

Identification of differentially expressed genes from spinal cord after firearm injury to rabbit sciatic nerves

GResearchInstituteofSurgery ,DapingHospital,ThirdMilitaryMedicalUniversity ,Chongqing 4 0 0 0 4 2 ,China (WangJM ,LiBC ,ChenL ,WangGBandZhangLC) Correspondingauthor:Tel:86 2 3 6 875 75 72 ,E mail:jmwang@public .cta .cq .cnThisprojectwassupportedbytheKeyStateDevelopmentProgramforBasicResearchofChina (No .19990 5 4 2 0 6 ) .eneregulationofnerveregenerationisanexcitingareainbiomedicine .Therehavebeenmanyreportsabouttheregulationgenesofperipheralnerveregeneration .Generegulationofne…     

dentification of differentially expressed genes from spinal cord after firearm injury to rabbit sciatic nerves

Objective: Peripheral nerve regeneration depends on gene regulation by central neurons. To search for more effective treatment methods to improve the regeneration of wounded peripheral nerves, gene expression profile of spinal cord after firearm injury to rabbit sciatic nerves are studied with DNA micro-array technique. Methods: A total of 54 rabbits were randomly divided into 4 groups: Groups dl, d3, d7 and normal control group. Lumbar spinal cords were sampled. RNAand mRNA were extracted, labeled by Cy3 and Cy5, and analyzed by mouse_8192S gene chips. Results: A total of 1367, 923, and 61 genes with differential expression were found on day 1, day 3, and day 7 after trauma respectively. Five expressed sequence tag (EST) sequences demonstrated differential expression during 7 days after trauma. Conclusions: There is complex gene profile with differential expression after firearm nerve injury, among which AW701496, U84291, W13926, X04017 andAW822394 EST sequences may be important regulation factors that involved in regeneration of peripheral nerve injury.     

FK506局部缓释膜片促进周围神经再生的临床应用研究

目的临床观察在神经缝合口周围置入FK506高分子缓释膜片后对神经再生的影响。方法?选取同一时间段(4个月内)，在腕横纹至肘上5cm处因切割伤而导致正中神经或尺神经断伤的急诊病例16例。结合病人是否接受FK506治疗的意愿分为实验组及对照组，每组8例。实验组用9-0无创尼龙缝线将神经两断端作端端缝合，并将含有20mg FK506的高分子可生物降解膜片环绕神经缝合口一圈后用筋膜等软组织覆盖修复的神经和膜片。将膜片制成以1mg／d的速度释放，共20d。对照组仅用同法修复神经。结果术后1周起随访至2年。实验组在术后14周肌电图检测即有新生电位出现，较对照组提前4周。术后3～12个月测定，实验组感觉神经再生速度平均为3．1mm／d，明显快于对照组的1．7mm／d。实验组远期功能恢复的优良率也优于对照组。结论从FK506的药理作用和应用结果分析，FK506具有针对性促进周围神经再生的作用。     

Regeneration of the rat sciatic nerve after different conditioning lesions: effects of the conditioning interval

Regeneration of the rat sciatic nerve was studied after a crush lesion (test lesion) on nerves previously subjected to a conditioning lesion. The test lesion was made approximately 30 mm proximal to the conditioning lesion. The period between the conditioning lesion and the test lesion was varied. Regeneration was measured by the pinch test. The conditioning procedure increased the rate of axonal elongation and decreased the initial delay. Conditioning intervals between 14 hours and 4 days were sufficient to increase the regeneration distance significantly, but only until day 4. If the conditioning interval was prolonged to 7 or 14 days, the conditioning effect persisted until day 6. A conditioning effect also was produced by transection of the sciatic nerve and by local compression produced with a silicone tube. The results of this study demonstrate that the type of injury and the conditioning intervals are important determinants in producing the conditioning effect in the rat.     

Chronic reduction in renal mass in the rat attenuates ischemia/reperfusion injury and does not impair tubular regeneration

It is not known whether a kidney with chronic structural and functional changes is more vulnerable to an acute renal insult, and whether its regeneration capacity after injury is altered. To study this question, Lewis rats were submitted 10 wk after 5/6 nephrectomy to an ischemic insult of 60 min (remnant kidney [RK] group). Functional and morphologic data of the RK group were compared with data obtained in 10-wk uninephrectomized (1K) and normal (2K) Lewis rats with unilateral and bilateral renal ischemia, respectively. The acute postischemic decrease in creatinine clearance was smallest in the RK group, followed by the 2K and 1K groups, respectively. At days 1 and 3, fewer proximal tubules in the outer stripe of the outer medulla of the RK and 2K groups had undergone acute tubular necrosis compared with the 1K group. The mean percentage of tubules with signs of regeneration was maximal at day 3 in the three experimental groups. At day 10, regeneration was almost complete in the three groups. The number of leukocytes (OX1+ cells) present in the RK before ischemia did not increase after ischemia/reperfusion injury (377 +/- 146 cells/mm2 at day 0) in contrast to the 1K and 2K groups. In the latter groups, the number of leukocytes had increased gradually, reaching a maximum at day 15 (1K: 960 +/- 308 cells/mm2) and day 10 (2K: 668 +/- 164 cells/mm2), respectively. In conclusion, this study has shown that an RK exhibiting chronic morphologic changes of interstitial fibrosis and tubular atrophy is protected against ischemia/reperfusion injury, and that its regeneration capacity is preserved. The reperfusion injury is not followed by further accumulation of leukocytes, which were already present in the RK before ischemia.