细胞外ATP防治失神经肌肉萎缩的实验研究

目的　探索细胞外ATP是否对失神经支配肌肉有保护作用。方法　SD大鼠 12只 ,在梨状肌下缘切断坐骨神经 ,制作腓肠肌失神经支配模型。左侧为实验组 ,术后于腓肠肌内注射ATP 0 .1mg/d ;右侧为对照组 ,腓肠肌内注射等量生理盐水。于术后 8、12周取 2组标本称肌湿重 ,检测运动终板、肌纤维横截面积及组织学变化。结果　实验侧的腓肠肌饱满有弹性、色泽好 ;对照侧肌纤维萎缩变细、色泽苍白。实验组运动终板边缘清晰 ,终板乙酰胆碱酯酶染色较深。比较两组的运动终板平均灰度值和平均光密度值 ,差异有显著性意义 (t =3 .0 5 7、4.13 8,P <0 .0 5 ) ,两组肌纤维横截面积相比 ,差异有显著性意义(t =4.191,P <0 .0 5 )。结论　ATP具有明显延缓失神经肌肉肌萎缩和减轻皮肤溃疡的作用     

背根神经节感觉神经元延缓失神经支配肌肉萎缩作用的实验研究

通过建立臂丛节前损伤的模型,观察撕脱的背根神经节通过相连的外周神经是否对相应的骨骼肌有延缓萎缩的作用,以期寻找防止肌萎缩的方法。方法:选用雄性成年SD大鼠60只,随机分成2组。实验组:制成C_5C_6根性撕脱的模型,使拖出椎孔的背根神经节仅通过肌皮神经与完全失神经支配的肱二头肌有联系。对照组:于椎孔外切断C_5C_6神经根,并造成肱二头肌完全失神经支配。于术后1、2、3、4和5个月各时间段,分别测定肱二头肌纤颤电位波幅、肌张力、肌湿重、肌纤维截面积并观察背根神经节中感觉神经元的变化。结果:术后1～5个月背根神经节中均见到存活的感觉神经元;纤颤电位波幅实验组大于对照组;实验组肌张力于术后1、2个月时明显优于对照组;术后1、2、3个月,实验组的肌湿重、肌纤维截面积明显高于对照组。结论:在节前损伤1～3个月内,背根神经节中感觉神经元有延缓失神经支配骨骼肌萎缩的作用。     

^125I—酪氨酸在大鼠坐骨神经内转运的初步研究

目的：旨在探索临床应用同位素标记方法检测神经再生的可能性。方法：采用改良氯胺Ｔ法制备１２５Ｉ－酪氨酸，用微量注射器直接注射入大鼠坐骨神经干内。术后不同时间取样，以γ－计数器检测其放射性。结果：发现１２５Ｉ－酪氨酸可以被坐骨神经直接吸收并转运，吸收时间约２小时，转运速率约１ｍｍ／ｈ。结论：该结果为体内直接检测轴浆流转运提供了实验依据     

Motor reinnervation of a denervated muscle by using a sensory nerve: an experimental study on gluteus maximus muscle of the rat

PURPOSE: This study aimed at developing a new muscle reinnervation technique using a sensory nerve. METHODS: We attempted innervation of the rat gluteus maximus muscle using the lateral femoral cutaneous nerve (LFCN). We placed the gluteus maximus muscle into the fibroadipose tissue in the distribution of the LFCN in 24 rats. In one group, the original innervation remained intact. In the second and third groups, the muscles were denervated, and in the third group, the proximal end of the nerve to the gluteus maximus was sutured to the distal end of the divided LFCN. We compared muscle reinnervations of the groups by using electrophysiologic evaluation of the muscle contractions, light microscope evaluation of the axonal regenerations, and scanning electron microscope evaluation of the actin-myosin structures of the muscles at the end of an elapsed waiting period. RESULTS: At the end of electrophysiologic evaluation, the mean area of compound muscle action potentials measured in group 1 was 3.8 ms/mV; in group 2, 0.0; and in group 3 (experimental group), 0.5. Axonal regeneration was observed distal to the coaptation, and actin-myosin structures were mostly spared in group 3. CONCLUSIONS: This study explored the feasibility of a new flap prefabrication method that aims at developing reinnervation of a denervated muscle by means of a sensory nerve. In light of histologic and electrophysiologic findings, this type of reinnervation is possible.     

颈总动脉周交感神经网剥脱切除术后痉挛肌肉内酶与肌纤维结构的研究

目的　探讨交感神经切断后,痉挛肌肉内酶与肌纤维结构的改变。方法　将20只wistar大白鼠作成痉挛性模型,分成两组,随机选择1组行颈总动脉周交感神经网剥脱切除术,另1组作为对照,于术后第20天切取两组大鼠部分肱三头肌组织,采用(Ellman)爱尔蒙法及AU1000检测仪测定肌组织内乙酰胆碱酯酶活性和肌酸激酶含量,在IBAS图像分析仪上观察两组肌组织内快收缩肌纤维与慢收缩肌纤维的改变情况。结果　交感神经切断后,乙酰胆碱酯酶活性和肌酸激酶含量明显下降,分别从（3.37±1.01）U/g降至（2.15±1.42）U/g（P＜0.01）;（3582.90±1561.7）IU/L降至（420.10±73.55）IU/L（P＜0.01）,快肌纤维明显减少,从（275727.31±98240.23）μm     

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.     

颈上节交感神经切断后痉挛肌肉肌电图与肌纤维结构的改变

目的 探讨交感神经切断后,痉挛肌肉肌电图与肌纤维结构的改变。方法 将２０只Ｗｉｓｔａｒ大白鼠做成痉挛性模型,分成两组,随机选择１组行颈上节交感神经切断,另１组作为对照,于术后第８天用Ｄａｎｔｅｃ肌电图仪测量两组大鼠肱三头肌Ｆ波幅度。术后第２０天切取部分肱三头肌组织,在图像分析仪上观察两组肌组织内快收缩肌纤维与慢收缩肌纤维的改变情况。结果 交感神经切断后,肌电图上Ｆ波幅较未手术组明显下降,从０．２５     

内窥镜技术提高周围神经损伤疗效的实验研究

目的介绍应用内窥镜技术对神经缝合口再生质量早期作出准确判断及治疗的实验室依据。方法选用成年雄性比格犬12条,在月国窝上2cm切断坐骨神经后一期修复神经。术后用3种不同方法进行治疗,直至神经远端出现神经再生电位。A组(内窥镜手术组):术后2周起每周在内窥镜下作神经探查、松解术,检测缝合口远近端神经干动作电位(NAP)及电刺激治疗。B组(手术组):术后2周起每周在直视下进行与A组同样的手术、检测NAP和电刺激治疗。C组(保守治疗组):为对照组。术后观察动物功能恢复情况及定期进行电生理检查,观察小腿三头肌出现新生电位的时间。术后半年,手术探查神经缝合口情况,并行电生理检测。结果A、B2组在术后3周记录到神经新生电位已通过神经缝合口,术后6周于小腿三头肌记录到新生电位。C组于术后7周在小腿三头肌记录到新生电位。术后半年,A、B组的大体功能恢复,运动神经传导速度(MNCV)和复合肌肉动作电位(CMAP),其差异无统计学意义,但均优于C组(P<0.05)。结论应用内窥镜技术早期判断神经修复后神经再生的质量及治疗效果均明显优于保守治疗组,为临床应用提供了实验室依据。     

Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?

Purpose  To investigate whether atrophy of the leg muscles present in congenital clubfoot (CCF) is primitive or secondary to treatment of the deformity. Methods  Magnetic resonance imaging (MRI) of both legs was taken in three cohorts of patients with unilateral congenital clubfoot (UCCF): eight untreated newborns (age range 10 days to 2 weeks); eight children who had been treated with the Ponseti method (age range 2–4 years); eight adults whose deformity had been corrected by manipulation and casting according to Ponseti, followed by a limited posterior release performed at age 2–3 months (age range 19–23 years). All of the treated patients wore a brace until 3 years of age. Muscles were measured on transverse MRI scans of both legs taken midway between the articular surface of the knee and the articular surface of the ankle, using a computer program (AutoCAD 2002 LT). The same program was used to measure leg muscles in the histologic cross sections of the legs of two fetuses with UCCF, spontaneously aborted at 13 and 19 weeks of gestation, respectively. Measurements of the whole cross section of the leg (total leg volume: TLV), of the muscular tissue (muscular tissue volume: MTV), and of the adipose tissue (adipose tissue volume: ATV) of the tibia, fibula, and of the other soft tissues (tendons, nerves, and vessels) were taken by using an interactive image analyzer (IAS 2000, Delta System, Milan, Italy). Results  Marked atrophy of the leg muscles on the clubfoot side was found in both fetuses and untreated newborns, with a percentage ratio of MTV between the normal and the affected leg of 1.3 and 1.5, respectively. Leg muscle atrophy increased with growth, and the percentage ratio of MTV between the normal and the affected leg was, respectively, 1.8 and 2 in treated children and adults. On the other hand, fatty tissue tended to increase relatively from birth to adulthood, but it could not compensate for the progressive muscular atrophy. As a result, the difference in TLV tended to increase from childhood to adulthood. Conclusions  Our study shows that leg muscular atrophy is a primitive pathological component of CCF which is already present in the early stages of fetal CCF development and in newborns before starting treatment. Muscular atrophy increases with the patient’s age, suggesting a mechanism of muscle growth impairment as a possible pathogenic factor of CCF. The authors certify that their institution has approved the reporting of this study, that all the investigations were conducted in conformity with ethical principles of research, and informed consent was obtained.     

小斜角肌的应用解剖

目的：探讨小斜角肌与臂丛神经的解剖关系，为临床治疗臂丛神经血管受压征提供解剖学依据。方法：观察２４具成人固定尸体中小斜角肌的形态及其与臂丛、血管的关系。２具成人新鲜尸体作Ｍａｓｓｏｎ染色，了解小斜角肌腱性组织成分。结果：４８侧尸体中，４２侧有小斜角肌，出现率为８７．５％，其止点的主要成分为腱性结构，臂丛神经下干从其止点上方跨过。结论：小斜角肌存在广泛，是引起臂丛神经血管受压征的因素之一。在臂丛神经血管受压征的手术中，应在切断前、中斜角肌时，同时切断小斜角肌     

Effect of Achilles tenotomy on congenital clubfoot-associated calf-muscle atrophy: an ultrasonographic study

Background

The Ponseti method for treating congenital clubfoot requires Achilles tenotomy to be performed toward the end of serial casting. However, it remains unclear if Achilles tenotomy has a negative effect on clubfoot-associated calf-muscle atrophy. We therefore investigated this issue by ultrasonographic examination.

Materials and methods

We studied 36 patients with congenital clubfoot who were treated with the Ponseti method and underwent Achilles tenotomy. Only unilateral cases were evaluated to enable comparison of the severity of atrophy and its changes over time between affected and unaffected sides. Tenotomy was performed at a mean age of 10.2 weeks after birth (range 8–16 weeks). The transverse and anteroposterior diameters of the calf muscles on the unaffected and affected sides were measured ultrasonographically by two examiners. The mean observation period was 27 months (range 24–34 months). Measurements were performed within 6 months after tenotomy, between 7 and 17 months after tenotomy, and at the final assessment. Differences between the diameters of the affected and unaffected sides at each time point, and changes in the diameters over time were determined. The data were analyzed by use of one-way ANOVA and repeated-measures ANOVA.

Results

Tendon healing and gliding were achieved in all cases. There were significant differences between the diameters of the unaffected and affected sides at all measurement points (transverse p < 0.005, anteroposterior p < 0.01). The diameters of calf muscles on both sides increased significantly over time (p < 0.0001). The patterns of change in diameter were similar on both sides.

Conclusion

The transverse and anteroposterior diameters of the calf muscles differed significantly between the affected and unaffected sides after Achilles tenotomy, but there were no significant differences in changes over time. These results suggest that Achilles tenotomy had no negative short-term effects on calf-muscle atrophy associated with clubfoot.     

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。     

外源性表皮生长因子促进鼠坐骨神经再生的实验研究

目的 评价外源性表皮生长因子（exogenous epidemal growth factor,EGF）对神经再生的影响。方法 雄性SD大鼠48只,建立成鼠坐骨神经挤压伤模型。按术后注射药物的不同成分2组,每组24只鼠。损伤对照组：在神经损伤处注射生理盐水5μl;EGF组：注射EGF／生理盐水液（10μg/5μl）。于术后2、4、6周3个时间点测定坐骨神经功能指数、CMAP的潜伏期、最大语诱发电位的恢复率、组织学检测、电镜超微结构观察。结果 坐骨神经功能指数恢复率在各时间点,EGF组无明显优于对照组（P＜0．01）。CMAP潜伏期的延迟率,EGF组明显小于对照组（P＜0．01）;诱发电位恢复率EGF组明显好于对照组（P＜0．01）。组织学检查：有髓神经纤维数在术后2、4周时EGF组明显多于对照组（P＜0．01）;各时间点有髓神经纤维直径及截面积,EGF组明显优于对照组（P＜0．01）。超微结构观察：EGF组再生神经的有髓纤维数,髓鞘厚度,髓鞘的成熟度明显好于对照组。结论 外源性EGF对神经的再生和功能恢复有一定的作用。     

颈交感神经网切除对肢体痉挛骨骼肌肌电图、酶及肌纤维结构的影响

目的　探讨交感神经切除后 ,痉挛肌肉内肌电图、酶及肌纤维结构的改变。方法　将2 0只Wistar大白鼠作成痉挛性模型 ,分成两组 ,随机选择 1组行颈总动脉周交感神经网剥脱切除及颈上节交感神经切除术 ,另 1组作为对照 ,于术后第 8天用Dantec肌电图仪观察肱三头肌F波幅度。术后第 2 0天切取两组大鼠部分肱三头肌组织 ,采用 (Ellman)爱尔蒙法测定肌组织内乙酰胆碱酯酶活性 ,在IBAS图像分析仪上观察两组肌组织内快收缩肌纤维与慢收缩肌纤维的改变情况。结果　交感神经切除后 ,F波幅度及乙酰胆碱酯酶活性明显下降 ,分别从 (0 .3 778± 0 .160 0 )mm降至 (0 .15 5 2± 0 .0 80 0 )mm (P <0 .0 1) ;(3 .3 7± 1.0 1)U / g降至(0 .84± 0 .65 )U / g(P <0 .0 1) ,快肌纤维明显减少 ,从 (2 75 72 7.3 1± 982 40 .2 3 )U/m2 降至 (8814 8.2 2± 3 5 111.18)U /m2 (P <0 .0 1) ,慢肌纤维显著增加 ,由 (4 2 710 .78± 2 885 8.3 7)U/m2 增至 (179184.73± 870 44 .5 9)U/m2(P <0 .0 1)。结论　交感神经切除后痉挛肌肉兴奋性下降     

Anterior versus posterior pin placement of pelvic C-clamp in relationship to anatomical structures: a cadaver study

OBJECTIVES: The objective of this study was to compare anterior and posterior pin placement of the pelvic C-clamp with specific reference to the proximity of the sciatic nerve, sciatic notch, hip joint capsule, and superior gluteal neurovascular bundle. METHODS: The pelvic C-clamp (Synthes, Paoli, PA) was applied to eight extracted pelvic specimens and five full cadavers (26 hips in total). Anterior and posterior pin placements were measured in relationship to the described anatomical structures. RESULTS: In 100% of the hips the distance from the posterior pin to the hip joint capsule was in 21 (80.8%), 23 (88.5%), and 20 (76.9%) of the hips, the anterior pin distances were greater than the posterior pin distances to the sciatic nerve, sciatic notch, and superior gluteal neurovascular bundle, respectively. CONCLUSIONS: Anterior pin placement is further from all anatomical structures studies with the exception of the hip joint capsule. The posterior pin was closer to the sciatic nerve, sciatic notch, and superior gluteal neurovascular bundle in all cases. Clinical decision-making for C-clamp placement should be individualised on a case-by-case basis.     

生物素葡聚糖胺观测周围神经局部轴突运输的实验研究

目的 研究神经示踪剂生物素葡聚糖胺（BDA）用于直观观察周围神经局部轴突运输的可行性。方法 （1）显露双侧兔坐骨神经，于实验侧及对照侧坐骨神经干注射不同浓度、不同剂量BDA，对照侧注射生理盐水，术后6、12、24、48h取样。于光镜及共聚焦显微镜下观察样本。（2）将兔左侧坐骨神经横断损伤并缝合，分别于术后1～6周于损伤近侧神经干注射10％BDA，12h后取标本观察。结果 10％BDA可清晰地在周围神经轴突内显像，操作简单，结果易于观察。同时，坐骨神经断伤术后3周时有明确的轴浆运输的恢复。结论 BDA神经干局部注射后能较清楚而直观地显示局部轴突运输的情况。     

人羊膜上皮细胞对大鼠坐骨神经再生影响的实验研究

目的 通过实验研究了解人羊膜上皮细胞(human amniotic epithelial cells,HAECs)对大鼠坐骨神经再生的促进作用.方法 取60只SD大鼠随机分为两组,羊膜细胞组和对照组,各组再分为2周和4周组,每组15只.制作大鼠周围神经损伤再生室模型,HAECs组局部应用培养的HAECs,对照组局部使用等量的生理盐水.术后分别于2周、4周检测神经传导功能和HE染色观察神经纤维形态学变化.结果 术后2周两组的神经电生理及组织学检测比较差异无统计学意义;4周HAECs组的大鼠坐骨神经传导功能明显恢复,HE染色显示术后坐骨神经手术部位出现大量炎性肉芽组织,呈现纤维性修复,吻合口以远HAECs组神经纤维形态结构较对照组完整,神经纤维与髓鞘直径均较对照组大.结论 HAECs移植可加速大鼠坐骨神经损伤后神经传导功能恢复,有助于有髓神经纤维损伤后的轴突与髓鞘的再生修复.

Abstract：

Objective To study the effects of human amniotc epithelial cells (HAECs) on regeneration of rat sciatic nerve. Methods Sixty SD rats were randomly divided into two groups, the HAECs group and control group. Each group was further divided into two week group and four week group, with 15 rats each. The sciatic nerve was cut and the regeneration chamber was created. The HAECs were implanted into the regeneration chamber in the HAECs group and normal saline was injected into the regeneration chamber in the control group.Electro-physiological and the histological study was done at two weeks and four weeks after the surgery. The results of nerve conduction study and HE staining of regenerating nerve fibers were analyzed statistically.Results There were no statistically significant differences between the two groups at two weeks post-operatively.At four weeks, the experimental group showed significantly higher nerve conduction velocity and amplitude of evoked potentials comparing to those of the control group. Nerve fibers and inflammatory granulation tissue was seen near the lesion site by HE staining in the control group, whereas the HAECs group showed more integrated nerve fihers and mature myelination distal to the lesion site. Conclusion The application of human amniotic epithelial cells may enhance nerve regeneration in rats.     

旋后肌肌支移位术的解剖学研究

目的 通过对桡神经旋后肌肌支和骨间后神经的显微解剖,为旋后肌肌支移位术提供解剖学依据,并设计旋后肌肌支移位术的最佳手术入路.方法 选择13侧甲醛固定成人上肢标本,解剖肘以远桡神经及各肌支,记录旋后肌肌支及骨间后神经的形态特征、分布情况和直径.结果 旋后肌肌支一般有3支,旋后肌Frohse弓近端2支,旋后肌肌管内1支,管外肌支恒定,可直接与骨间后神经缝合,且口径匹配.结论 旋后肌肌支可用来移位修复骨间后神经,为臂丛神经中下干损伤患者提供一种新的神经移位方式.     

促红细胞生成素促进大鼠坐骨神经再生作用的实验研究

目的 探讨促红细胞生成素(Erythoropoietin,EPO)对大鼠坐骨神经损伤修复后神经再生的影响,为周围神经损伤的临床治疗提供实验依据.方法 雄性SD大鼠40只,随机分为两组,即EPO组和神经生长因子(NGF)组,用硅胶管桥接10 mm的坐骨神经缺损,EPO组和NGF组分别注射EPO和NGF.术后4周和8周时每组分别提取10只大鼠,以坐骨神经功能指数(SFI)、运动神经传导速度(MNCV)、形态学观察和蛋白基因产物9.5(PGP 9.5)免疫组织化学染色,评估EPO对大鼠坐骨神经再生的影响.结果 术后4周SFI,EPO组为[(-78.85±3.87),x-±s,下同],NGF组为(-79.98±4.58),差异无统计学意义(P>0.05);术后8周SFI,EPO组为(-60.26±2.91),NGF组为(-64.65±4.11),差异有统计学意义(P<0.05).术后4周和8周时,EPO组MNCV、有髓神经纤维数目以及PGP9.5免疫阳性神经纤维的平均光密度和积分光密度均优于NGF组,差异有统计学意义(P<0.05).结论 EPO 能促进大鼠坐骨神经损伤后的修复与再生.