实验性不同类型大鼠臂丛根性损伤后脊髓运动神经元存活情况观察

目的 研究臂丛神经根性切断伤与根性撕脱伤后脊髓前角运动神经元的存活情况。方法 对76只健康成年SD大鼠,按手术先后顺序分成臂丛神经根性切断伤组和根性撕脱伤组,两组按术后9个不同的时间组取材,每组4只大鼠,共72只大鼠。另外4只为正常对照组。取了脊髓标本后,观察颈髓前角运动神经元数目的变化。结果 臂丛神经根性切断伤后,各时间组的脊髓前角运动神经元数目和术前无明显变化;而根性撕脱伤组于术后1周其神经元数目开始减少,术后2周时神经元数目比正常对照组减少30％,术后6周时减少70％。撕脱伤组与切断伤组相比,损伤1周后,各时间组的差异均有显著性意义（X^2＝3．922－17．21,P＜0．01）。结论 臂丛神经根性切断伤其脊髓运动神经元和术前比无明显变化,而臂丛神经性撕脱伤后其脊髓运动神经元有死亡,死亡速度快,死亡程度高。     

植物抗氧化剂TA9901保护臂丛撕脱后运动神经元的实验研究

目的　观察植物抗氧化剂TA990 1对臂丛撕脱后脊髓运动神经元c jun基因的表达和存活的影响。方法　成年SD雌性大鼠 90只分成 2组 ,治疗组行右侧臂丛神经根撕脱术后 ,每天腹腔注射质量浓度为 0 .5%的TA990 1溶液 1ml,对照组注射生理盐水。治疗后 4h～ 6周处死动物行c jun免疫组织化学和中性红染色 ,定量比较两组大鼠损伤侧c jun基因表达阳性和存活运动神经元数目。结果　治疗后 3d ,5d ,1周和 2周 ,治疗组的c jun基因表达阳性运动神经元数目均多于对照组 ,两组间各时间点的差异均具有非常显著意义 (P <0 .0 1)。治疗后 2、4、6周 ,治疗组存活运动神经元数目多于对照组 ,两组间的差异均有非常显著意义 (P <0 .0 1)。结论　TA990 1能增强受损运动神经元c jun基因的表达 ,提高臂丛撕脱后运动神经元的存活率     

臂丛损伤神经干细胞脊髓前角移植后分化情况及对运动神经元的保护作用

目的观察臂丛根性撕脱伤后将脊髓源性神经干细胞(neuralstemcell,NSC)移植于脊髓前角后的存活、分化情况及对脊髓前角受损运动神经元的保护作用。方法取新生鼠脊髓,分离获得脊髓源性神经干细胞,体外培养、扩增、鉴定、5溴2-脱氧尿苷(BrdU)标记。取SD大鼠60只,随机分成实验组、对照组和单纯组。从后路制备C5~C7臂丛神经根性撕脱伤动物模型。实验组移植神经干细胞于C6脊髓前角,对照组移植灭活神经干细胞,单纯组不作移植。术后1、2、4、8、12周取脊髓标本进行组织学与免疫组化染色观察。结果神经干细胞移植入脊髓后能存活、分化;臂丛根性撕脱伤后脊髓前角运动神经元数目明显减少;实验组神经干细胞移植后2、4、8、12周各个时间点运动神经元的存活率均高于对照组和单纯组。结论臂丛根性撕脱伤脊髓前角神经干细胞移植后能存活并分化为神经元及星型胶质细胞,脊髓源性神经干细胞移植能明显减少前角运动神经元的继发性死亡,对脊髓前角受损运动神经元有保护作用。     

神经干细胞对脊髓前角运动神经元保护作用的实验研究

目的观察臂丛根性撕脱伤后神经干细胞脊髓内移植对前角运动神经元的保护作用。方法取孕龄15～18d胎鼠脑组织，分离获得神经干细胞，在体外培养、扩增，并用5溴-2脱氧尿苷(BrdU)标记。取Wistar大鼠72只，随机分成实验组与对照组。先将C5～T1神经根撕脱，实验组把体外培养的神经干细胞移植于C5～T1脊髓节段前角附近，而对照组则用缓冲液替代神经干细胞。术后1、2、4、6、8、12周取脊髓标本进行组织学与免疫组化染色观察。结果臂丛根性撕脱伤后脊髓前角运动神经元数目明显减少，到术后12周时，对照组运动神经元减少达80．3％，实验组达63．7％。并且，各时间点实验组运动神经元的存活率均高于对照组。实验组脊髓前角内可见散在但仍保持未分化特征的神经干细胞。结论神经干细胞在植入臂丛根性撕脱伤的脊髓后能存活，并能明显减少前角运动神经元的继发性死亡。     

椎管内外神经根移位整体化治疗臂丛神经根性撕脱伤的实验研究

目的：研究臂丛神经根性撕脱伤后,椎管内、外神经根移位治疗臂丛神经根性撕脱伤的疗效。方法随机选取SD大鼠60只,随机分为实验组及对照组。实验组采用椎管内C5,C6神经根原位修复及健侧C7神经移位修复C8,T1神经根治疗臂丛根性撕脱伤;对照组为膈神经修复肌皮神经,副神经修复肩胛上神经,健侧C7移位修复C8,T1神经根治疗臂丛根性撕脱伤。术后6个月时取材,进行电生理检测,肌肉湿重的测量,肌肉纤维横截面积的检测,HE染色检测观察肌纤维数量,电镜观察神经纤维数量及神经直径。结果实验组神经损伤修复6个月时,其肌肉湿重、肌肉纤维横截面积、肌肉运动诱发电位恢复率、神经生长情况优于对照组。结论椎管内神经根原位修复及椎管外神经根移位整体化治疗臂丛神经根性撕脱伤,无论从肌肉湿重、还是肌肉纤维横截面积比率,或者肌肉运动诱发电位及再生神经生长情况等方面,都取得了良好的效果。     

成年大鼠全臂丛根性撕脱伤后初级体感皮层可塑性变化的脑电生理研究

目的 探讨成年大鼠一侧全臂丛根性撕脱伤后双侧初级体感皮层可塑性变化的规律。方法 将30只SD雄性大鼠分为6组，分为正常对照组和全臂丛根性撕脱伤术后1d、7d、1个月、3个月、1年共5个时间组，每组5只。采用体感皮层诱发电位（somatosensory evoked potential，SEP）记录法，定量评价一侧全臂丛根性撕脱伤后双侧初级体感皮层（Sm1）可塑性变化的时程。结果 术后不同时间段电刺激患爪正中神经支配区，在双侧Sm1均未诱发出SEP。电刺激健侧前爪正中神经支配区，在健爪同侧Sm1未记录到SEP，只在其对侧Sm1记录到SEP；但不同时间段的SEP位点数目均明显多于正常对照组。结论 成年大鼠的初级体感皮层仍具有可塑性，一侧全臂丛根性撕脱伤后诱发了双侧Sm1动态的功能重组。两大脑半球相对应的同位区域之间存在着维持半球间平衡和协调的特殊机制。健侧前爪体感代表区的扩大可提高健爪的感觉辨别能力，以部分代偿患肢感觉功能的丧失。     

Survival of injured spinal motoneurons in adult rat upon treatment with glial cell line-derived neurotrophic factor at 2 weeks but not at 4 weeks after root avulsion

We conducted a study of whether treatment with glial cell line-derived neurotrophic factor (GDNF) initiated at 2 or 4 weeks after spinal-root avulsion could promote survival and regulate neuronal nitric oxide synthase (nNOS) expression in adult rat spinal motoneurons. By 6 weeks after root avulsion, the treatment given at 2 weeks not only increased motoneuron survival (86.1% vs. 27.9%), but also reversed the atrophy of injured motoneurons and increased their somatic size (101.3% vs. 52.9%) in comparison to the untreated control group of animals. All surviving motoneurons in the GDNF-treated group showed immunoreactivity for choline acetyltransferase. In contrast, GDNF treatment at 4 weeks post-injury failed to promote motoneuron survival (33.1% vs. 27.9%) at 6 weeks compared to the control group. Both the 2- and 4-week post-injury treatments downregulated nNOS expression. This finding suggests that injured adult motoneurons die shortly (a few weeks in the rat) after root avulsion injury, but can be saved from degeneration by treatment within the proper time frame after injury, which in the case of GDNF treatment in rats, appears to be within 2 weeks of the avulsion injury of the spinal root. These findings provide useful information for choosing the best time frame for the potential clinical treatment of brachial plexus avulsion.     

成年大鼠全臂丛根性撕脱伤后对侧运动皮层可塑性变化的实验研究

目的 探讨成年大鼠全臂丛根性撕脱伤后不同时间段对侧运动皮层的可塑性变化。方法 将30只SD雄性大鼠分为6组，即正常对照组和全臂丛根性撕脱伤术后1d、7d、1个月、3个月、1年共5个时间组，每组5只。采用皮层内微电极电刺激技术，定量评价大鼠左前肢代表区内的可塑性变化。结果 术后不同时间组在原前肢代表区内可诱发出不同的运动类型，包括左侧胡须、下颌、颈部和左下肢4个部位点的运动，但只有颈部位点自始至终占据着术前前肢代表区。结论 成年大鼠的运动皮层仍具有可塑性，术后对侧运动皮层在术前前肢代表区发生了功能重组，并且这种功能重组是动态变化的。瘫痪肢体以上最临近部位的肌肉控制力其代偿性明显增强。     

高分辨率MRI诊断臂丛根性撕脱伤的临床研究

目的 探讨臂丛根性撕脱伤的高分辨率磁共振成像特点,为早期诊断臂丛根性撕脱伤提供帮助.方法 筛选于2006年2月-2011年2月收治臂丛损伤的病例,术前均行臂丛MRI检查,术中探查证实为臂丛根性撕脱伤45例,总结臂丛根性撕脱伤的高分辨率磁共振表现特点及MR诊断臂丛根性撕脱伤的应用价值.结果 臂丛根性撕脱伤的MRI表现为:①创伤性脊膜囊肿最为常见,有42例,出现率为93.3％;②脊髓偏移,有25例,出现率为55.6％;③脊神经前后根消失,有8例,出现率为17.8％;④“黑线”征,有18例,出现率为40.0％.核磁共振对臂丛根性撕脱伤诊断的敏感性为95.7％,特异性为77.8％,准确性为94.6％.结论 臂丛根性撕脱伤患者的MRI中以创伤性脊膜囊肿最为常见,可对臂丛损伤的定位诊断及手术治疗提供参考依据.     

Experimental studies on surgical treatment of avulsed spinal nerve roots in brachial plexus injury.

This review summarises studies aiming at a surgical treatment of spinal nerve root avulsions from the spinal cord in brachial plexus lesions. After dorsal root injury, regrowth of nerve fibres into the spinal cord occurs only in the immature animal. After ventral root avulsion and subsequent implantation into the spinal cord, neuroanatomical and neurophysiological data show that motoneurons are capable of producing new axons which enter the implanted root. Intra-neuronal physiological experiments demonstrate that new axons can conduct action potentials and elicit muscle responses. The neurons are reconnected in segmental spinal cord activity and respond to impulses in sensory nerve fibres. In primate experiments, implantation of avulsed ventral roots in the brachial plexus resulted in functional restitution. These studies indicate the possibility of surgical treatment of ventral root avulsion injuries in brachial plexus lesions in humans.     

臂丛神经根性撕脱伤后神经营养因子在脊髓及肌肉中表达的变化

目的：通过观测臂丛神经根性撕脱伤后脊髓前角运动神经元及肌肉组织内神经营养因子表达的变化。探讨臂丛神经撕脱伤后中枢运动神经元,靶器官的功能改变可能对神经再生产生的影响。方法：清洁级Wistar大鼠48只,随机分成正常对照组和损伤术后1天,1,4,8和12周共六组,损伤组均从前路造成臂丛颈5,6,7神经根性撕脱伤,按各组所示时间取脊髓及肌肉分别检测碱性成纤维细胞生长因子（bFGF)蛋白及mRNA,神经生长因子（NGF）蛋白的表达,并采用计算机图像分析系统对组织切片中bFGF蛋白及mRNA,NGF蛋白进行半定量分析,比较,结果：臂丛神经根性撕脱伤后,肱二头肌内NGF蛋白表达增高,1天时达到高峰,随后下降,3个月时仍高于对照组,而脊髓前角运动神经元bFGF蛋白及mRNA的表达在伤后亦升高,1周时达到高峰,随后下降,3个月时下降到稍低于正常水平,结论：臂丛神经根性撕脱伤后神经营养因子在中枢神经元及靶器官内表达增高,可能起保护神经元,促进神经再生的作用。     

健侧C_7神经根移位治疗臂丛神经根性撕脱伤的疗效观察

目的观察健侧C7神经根移位修复臂丛神经根性撕脱伤术后患侧肢体运动、感觉功能恢复情况,以及该术式对健侧肢体的影响。方法 2008年8月-2010年11月,采用健侧C7神经根移位修复全臂丛神经根性撕脱伤22例。患者均为男性;年龄14～47岁,平均33.3岁。术前临床检查及电生理检测均确诊为全臂丛神经根性撕脱伤。其中修复正中神经16例,桡神经3例,肌皮神经3例;一期手术2例,二期手术20例。观察手术前、后患侧肢体运动、感觉功能恢复情况。结果 21例患者获随访,随访时间7～25个月,平均18.4个月。健侧C7神经根修复正中神经:屈腕肌肌力达3级或以上10例,屈指肌肌力达3级或以上7例;感觉恢复达S3或以上11例。健侧C7神经根修复肌皮神经:屈肘肌肌力达3级或以上2例;前臂外侧皮肤感觉达3级2例。健侧C7神经根修复桡神经(失访1例)伸腕肌肌力达3级1例;感觉恢复达S3 1例。结论健侧C7神经根全干移位修复全臂丛神经根性撕脱伤效果较好,分期手术是提高疗效的重要因素。     

Effect of ipsilateral C7 nerve root transfer on restoration of rat upper trunk muscle and nerve function after brachial plexus root avulsion

The effects of ipsilateral cervical nerve root transfer on the restoration of the rat upper trunk muscle and nerve brachial plexus root avulsion were studied. After simulated root avulsion of the upper trunk brachial plexus, 120 rats were randomly divided into 4 groups: (A) ipsilateral C7 root transfer group; (B) Oberlin group; (C) phrenic nerve group; and (D) no axillary nerve restoration group. At 3, 6, and 12 weeks postoperatively, Ochiai score, Barth feet overreaching test, Terzis grooming test, and indices of neurotization were determined in 10 rats from each group. Twelve weeks postoperatively, nearly all the behavioral, neuroelectrophysiological, and histological outcomes of the axillary nerve and deltoid muscle and some of the indices of musculocutaneous nerve and biceps brachii function in the ipsilateral C7 group were superior to those in the other 3 groups. No significant difference was found between the ipsilateral C7 group and the other 3 groups in recovery rate of wet biceps muscle weight. No significant difference was found between the ipsilateral C7 group and the Oberlin group in the recovery of the axillary nerve compound muscle action potential and biceps brachii cell size. No significant difference was found between the ipsilateral C7 group and the phrenic nerve and no axillary nerve restoration groups in amplitude recovery rate of musculocutaneous nerve compound muscle action potential. No significant difference was found between the ipsilateral C7 and the Oberlin groups in the early recovery of musculocutaneous nerve compound muscle action potential, but recovery was significantly better in the ipsilateral C7 group at 12 weeks. Ipsilateral C7 root transfer can improve the quality of restoration of muscle and nerve function in the rat upper trunk after brachial plexus root avulsion.     

经纵隔内切取长段膈神经与下干后股直接吻合重建全臂丛撕脱伤的伸指功能

目的 为全臂丛神经撕脱伤的伸指功能重建寻找一种新的有效的神经移位方法.方法 经纵隔直视下切取一段膈神经,以增加其长度.锁骨上、下臂丛神经探查联合切口,截断锁骨,找到下干后股,向近端干支分离后切断,将膈神经与下干后股直接吻合.本组12例臂丛神经撕脱伤,男10例,女2例;年龄6～39岁,平均28岁.伤后到手术时间2～11个月,平均6个月,其中全臂丛神经撕脱伤11例,中、下干撕脱伴上干不全损伤1例.术前需胸透及电生理检查均证实患侧膈神经功能良好.结果 经纵隔内直视下切取膈神经可使其长度增加3～7cm,平均4cm.12例均实施了膈神经与下干后股的直接吻合,其中3例术后随访1年以上,有2例指总伸肌肌力恢复到2级,另1例吸气时指总伸肌内有新生电位出现.结论 经纵隔内切取膈神经可使其长度明显延长,可与下干后股进行直接吻合重建伸指功能,初步临床应用证实是可行的.     

A new model for the study of neuropathic pain after brachial plexus injury

The study was to introduce a new and reliable behavioral model of upper trunk of brachial plexus avulsion for the study of persistent neuropathic pain. 60 rats were divided into three groups randomly: upper trunk of brachial plexus avulsion (UTBPA) group (20), global brachial plexus avulsion (GBPA) group (20), and sham- operated group (20). The animals were tested for behavioral responsiveness before surgeries and 3, 7, 14, 21, 28, 56, 84 days after surgeries. The injured level of spinal cord was resected and the sections were processed for GFAP (astrocyte) and Iba1 (microglia) immunohistochemistry 3 weeks after surgeries. The UTBPA group developed significant signs both of mechanical and cold hypersensitivity, which matched the immunohistochemistry result, as well as the nature of avulsion was close to the clinical type of injury, the UTBPA group could be used as a suitable and effective persistent neuropathic pain model following brachial plexus injury.     

健侧C7神经根移位对修复全臂丛根性撕脱伤术后运动皮层重塑的影响

目的 探讨大鼠全臂丛根性撕脱伤行健侧C7神经根移位术后运动皮层重塑的变化,比较不同术式对运动皮层重塑的影响.方法 建立幼年Sprague-Dawley大鼠左侧全臂丛根性撕脱伤模型90只,随机采用三种不同术式健侧C7神经根移位术治疗,包括健侧C7神经根移位至上干前股(A组,30只),移位至正中和肌皮神经(B组,30只)以及移位至正中神经(C组,30只).分别于术后1.5、3、6、9、12个月,以微电极刺激技术检测各组大鼠患肢支配区在双侧大脑运动皮层的分布.另取6只成年SD大鼠为空白对照组.结果 术后1.5个月,各实验组大鼠患肢支配区仅位于同侧运动皮层;术后3和6个月,患肢支配区均位于双侧运动皮层;术后9个月,A组大鼠患肢支配区已达对侧运动皮层;术后12个月,各实验组大鼠患肢支配区均位于对侧运动皮层,B组运动皮层重塑程度优于C组.结论 幼年大鼠健侧C7神经根移位术后运动皮层患肢支配区可实现由同侧皮层到双侧再到对侧皮层的跨大脑半球功能重翅.健侧C7神经根移位术受体神经的类型影响术后运动皮层重塑,移位至臂丛上干前股或同时移位至正中和肌皮神经更有利于实现运动皮层的跨半球重塑.     

Phrenic nerve end-to-side neurotization in treating brachial plexus avulsion: an experimental study in rats

The aim of this study was to extend the clinical application of phrenic nerve neurotization in treating brachial plexus avulsion injury, reducing the possible damage on the diaphragm function. Fifty-one male Sprague-Dawley rats and 9 transgenic rats were used in this study. Evaluations including behavioral observation, histology, and electrophysiology study were performed postoperatively. The functional recovery of rats with the end-to-side neurorrhaphy reached 80% of those with end-to-end neurorrhaphy, and the function of diaphragm was preserved. The fluorescence study revealed abundant collateral sprouting of the phrenic nerve axons through the coaptation site in all the experimental groups. The study showed that the end-to-side neurorrhaphy in a helicoid manner and the standard end-to-side neurorrhaphy were effective in the treatment of brachial plexus root avulsion injury with little harm to the function of diaphragm. This will extend the clinical application of phrenic nerve neurotization in treating brachial plexus avulsion injury.     

二期多组神经移位治疗臂丛神经根性撕脱伤的临床应用和疗效

目的 分析治疗臂丛神经根性撕脱伤的二期手术方法及其效果。方法 2001年8月～2003年4月8例全臂丛神经根性撕脱伤患者，年龄18～38岁。平均伤后6个月内，均应用以下术式治疗。手术步骤：一期手术，膈神经移位至臂丛上干前股，副神经移位至肩胛上神经；健侧C7神经移位至患侧尺神经；二期手术，第4、5、6、7肋间神经移位至桡神经和胸背神经，健侧C7神经经尺神经移位至正中神经。结果 术后8例均获随访，时间为二期术后l3～25个月，平均21个月。所有患者均有不同程度恢复，相应靶肌肉肌力恢复大于或等于M3为有效恢复，肌皮神经有效恢复6例，恢复率为75．0％；肩胛上神经有效恢复3例，恢复率为37．5％；桡神经有效恢复3例，恢复率为37．5％；胸背神经有效恢复6例，恢复率为75．0％；正中神经有效恢复5例，恢复率为62．5％。感觉恢复情况：正中神经感觉4例为S3，3例为S2，1例为S1。结论 二期多组神经移位安全有效，对部分早期臂丛神经损伤并要求缩短手术次数的患者，是一种可选择的方法。     

臂丛神经根性撕脱伤患者三叉神经支配区感觉改变与交感神经功能状态关系的探讨

目的：研究臂丛神经根性撕脱伤患者面部三叉神经支配区感觉变化与交感神经功能状态的关系。方法：对38例臂丛神经根性撕脱伤患者面部三叉神经支配区感觉和交感神经功能状况进行临床检查与分析。同时对臂丛神经，膈神经和融神经损伤情况进行电生理学检查，结果：38例臂丛神经根性撕脱伤患者中，19例伴有交感神经损伤，13例面部感觉减退，交感神经功能减退的19例患者中，12例伴有面部感觉减退（63.2%)；面部感觉减退的13例患者中，12例伴有交感神经功能减退（92.3%)，臂丛神经根性撕脱伤患者受伤短期内，可有患侧头面部交感神经功能和面部感觉减退，一段时期以后，患侧面部三叉神经支配区感觉可随交感神经症状的消失而逐渐恢复，结论：臂丛神经根性撕脱伤患者常伴有颈部交感神经损伤，可能患侧面部三叉神经支配区感觉减退与颈部交感神经损伤有关。     

Neurotizations by means of the cervical plexus in over 100 patients with from one to five root avulsions of the brachial plexus

In the years 1982–1991, we treated over 100 patients with avulsion of from one to five roots in perinatal (n = 21) and traumatic (n = (81) lesions of the brachial plexus. Based on the clinical diagnosis and the surgical findings, we divided all operated patients into four groups: (1) avulsion of all roots or avulsions and disruption of the rest of the brachial plexus; (2) avulsion and disruption of one to four roots and preservation of some elements of the brachial plexus with fibrotic changes; (3) avulsion and disruption of one to three roots, with some elements showing no macroscopic changes; and (4) children with perinatal brachial plexus palsy. In cases of root avulsion, we performed neurotization from the cervical plexus, the accessory and intercostal nerves. In patients with One to three root avulsions, we have performed selective neurotization for 3 years. The best results were obtained in groups 3 and 4, but some improvement was also noted in the other groups. © 1993 Wiley-Liss Inc.