周围神经损伤的显微外科修复

目的 分析应用显微外科技术修复周围神经损伤的临床疗效.方法 自1997～2009年,用显微外科技术修复周围神经损伤176例197条神经,方法包括神经外膜缝合术、神经束膜缝合术、神经松解术及神经移植术.结果 术后经3～60个月随访,根据BMRC感觉、运动评价标准,其中疗效为优者84条,良者77条,优良率达81.73%.伤后24 h内修复者的优良率为93.52%,优于3个月内修复者.3个月内修复者优良率为79.31%,优于6个月后修复者.结论 应用显微外科技术对周围神经损伤的早期修复和显微镜下神经断端的精确对合可提高临床疗效.     

周围神经损伤的临床分析

目的分析应用显微外科技术治疗周围神经损伤的临床效果。方法应用显微外科技术治疗周围神经损伤26例,手术方法包括神经吻合,神经移植及神经松解,术后积极进行功能锻炼。结果均取得较满意的效果。结论周围神经损伤的早期诊断和准确定位及时进行显微外科修复及术后积极功能锻炼是获得满意效果的保障。     

102例甲床损伤的急诊修复

目的：介绍甲床损伤的急诊修复方法。方法：对于102例120指甲床损伤的患者进行显微修复,分别使用单纯缝合、断层甲床游离移植及全甲床游离移植。结果：术后随访3～6个月,以最后一次评定结果为疗效,120指疗效评定,优67指,良32指,可17指,差4指,总优良率82．5％。结论：应用显微无创技术进行甲床的修复与重建．可以减少后期畸形．有利于美观和功能。     

脊髓损伤截瘫致尿潴留患者拔管时机的选择

目的使脊髓损伤截瘫致尿潴留患者早期恢复排尿,拔管后能顺利排尿,减少再插管的痛苦,恢复自理能力。方法从2008年3月至2010年3月对鞍山市铁西医院收治的17例脊髓损伤尿潴留患者随机分成两组,参照组6例按照常规方式训练排尿,试验组9例选择早期带管顺利自主排尿后拔管。结果实验组患者均顺利排尿,避免了再插管的痛苦;参照组患者2例顺利排尿,4例重新下管。讨论脊髓损伤尿潴留的患者排尿功能的恢复是患者生命质量的重要体现,针对脊髓损伤尿潴留患者,拔管前的正确指导,拔管时机的掌握,拔管后的心理暗示是患者顺利排尿的基本要素。     

周围神经修复技术的研究进展

周围神经外科领域的进展就是显微外科技术的应用,这一应用极大地提高了周围神经损伤修复的质量.由于周围神经解剖和功能上的特殊性,神经功能的恢复仍不理想,各种周围神经修复技术仍然存在一定的局限性.     

牙冠延长术后最佳修复时机的选择

目的　探讨牙冠延长术后如何选择最佳的修复时机。方法　运用翻瓣联合骨切除的方法行牙冠延长术 ,选择术后 1周 (拆线 )时松动度 (movabledegree ,MD)为Ⅰ～Ⅱ度、缺损最深位点处暴露于龈上 - 1～ 1mm的 2 8颗患牙 ,记录术后 1周 (拆线 )、2～ 3周、4～ 5周、6～ 8周及 6个月的不同时期的MD和该位点处龈缘位置的变化情况 ,进行比较分析。结果　在术后 4～ 5周之内 ,MD及龈缘位置有显著改变 (P <0 0 5 ) ,而在 4～ 5周以后两项指标均无明显变化 (P >0 0 5 )。结论　牙冠延长术后 4～ 5周为永久性修复的最佳时机 ,它既不会影响到修复后的美观和功能的恢复 ,又最大限度地满足了患者尽早修复患牙的愿望     

周围神经移植联合神经营养因子治疗损伤脊髓的实验研究

目的 探讨周围神经移植联合神经生长因子(NGF)和脑源性神经生长因子(BDNF)对脊髓损伤的疗效。方法 用SD大鼠在胸8～胸9平面切除半侧4mm长脊髓制成半切模型,取自体肋间神经桥接脊髓缺损,并在局部持续灌注含NGF、BDNF生理盐水3天。3个月后由结构及功能二方面评价脊髓功能恢复情况。结果 术后3个月试验鼠后肢感觉、运动及运动功能改良Tarlov评分、斜板试验均优于对照组;肋间神经植入区见轴突再生,胶质细胞增生减少,雪旺氏细胞增殖;示踪剂通过植入区的近远端界面;体感诱发电位(SEP)磁刺激运动诱发电位(MEP)大部分恢复;MR示脊髓连续无中断。结论 肋间神经移植 NGF、BDNF能促进神经轴突的生长,抑制胶质细胞增生,在局部使雪旺氏细胞增殖,利于脊髓再生。     

手指屈肌腱损伤急诊显微外科修复

目的探讨手指屈肌腱损伤急诊显微外科修复方法及重要性。方法回顾性分析2000-2005年急诊收治145手指屈肌腱损伤患者治疗状况，根据屈肌腱Verdan分区及各区的解剖特点，应用显微外科技术采用不同的方法进行修复手指深浅屈肌腱。结果本组145例术后随访6～18个月，平均11个月。按TAM标准，优良率达82．06％。结论急诊显微外科修复方法对指屈肌腱损伤的治疗效果满意，手指屈功能恢复良好。     

周围神经损伤的康复治疗

目的探讨周围神经损伤的康复治疗方法 ,提高治疗水平,缩短神经恢复时限。方法根据神经损伤后的不同时期分别采用营养神经和物理治疗,运动训练和作业训练。结果随访6～21个月,29例患者中,优良26例。结论围神经损伤修复后,分不同阶段康复治疗是神经恢复的有效方法 。     

颅脑损伤昏迷患者气管套管拔管时机的选择

目的：探讨颅脑损伤后长期昏迷患者气管切开术后拔除气管套管的最佳时机的选择。方法：对56例颅脑损伤后长期昏迷患者气管切开术后拔除气管套管时机的选择进行分析。结果：55例气管切开术后患者因拔除气管套管时机选择恰当,成功拔管;1例因肺部感染再次行气管切开。结论：颅脑损伤后长期昏迷患者气管切开术后拔除气管套管的时机选择,不必等待患者清醒,综合分析具体拔管指征,选择适宜时机,即可拔除气管套管。     

Xenogeneic Decellularized Extracellular Matrix-based Biomaterials For Peripheral Nerve Repair and Regeneration

Peripheral nerve injury could lead to either impairment or a complete loss of function for affected patients, and a variety of nerve repair materials have been developed for surgical approaches to repair it. Although autologous or autologous tissue-derived biomaterials remain preferred treatment for peripheral nerve injury, the lack of donor sources has led biomedical researchers to explore more other biomaterials. As a reliable alternative, xenogeneic decellularized extracellular matrix (dECM)-based biomaterials have been widely employed for surgical nerve repair. The dECM derived from animal donors is an attractive and unlimited source for xenotransplantation. Meanwhile, as an increasingly popular technique, decellularization could retain a variety of bioactive components in native ECM, such as polysaccharides, proteins, and growth factors. The resulting dECM-based biomaterials preserve a tissue''s native microenvironment, promote Schwann cells proliferation and differentiation, and provide cues for nerve regeneration. Although the potential of dECM-based biomaterials as a therapeutic agent is rising, there are many limitations of this material restricting its use. Herein, this review discusses the decellularization techniques that have been applied to create dECM-based biomaterials, the main components of nerve ECM, and the recent progress in the utilization of xenogeneic dECM-based biomaterials through applications as a hydrogel, wrap, and guidance conduit in nerve tissue engineering. In the end, the existing bottlenecks of xenogeneic dECM-based biomaterials and developing technologies that could be eliminated to be helpful for utilization in the future have been elaborated.     

尿道下裂手术方法的选择

目的 探讨不同类型尿道下裂手术方法的疗效.方法 总结388例尿道下裂手术资料,分析不同术式与尿道狭窄及尿道瘘的发生率.结果 尿道口前移、阴茎头成形术(MAGP1)狭窄、尿道瘘发生率为零;Mathieu法的狭窄发生率为9.8%,尿道瘘发生率为5.7%;Denni s-Brown的狭窄、尿道瘘发生率分别为20%和20%;膀胱粘膜法的狭窄和尿道瘘发生率分别为8.6%和1 3%.结论 阴茎头、冠状沟型尿道下裂宜采用MAGPI法,阴茎体型宜采用Mathieu法,近端型宜用加盖岛状皮瓣法或Duplay十Duckett法,膀胱粘膜一期尿道成形术适用于各种类型尿道下裂.     

Exosomes as a Promising Therapeutic Strategy for Peripheral Nerve Injury

Peripheral nerve injury has a high incidence and often leads to severe losses of sensory and motor functions in the afflicted limb. Autologous nerve grafts are widely accepted as the gold standard for peripheral nerve repair, but the presence of inherent drawbacks dramatically reduces their usability. Numerous tissue engineering nerve grafts are developed as alternatives to autologous nerve grafts, and a variety of cells and neurotrophic factors are introduced into these grafts for improvement. However, they are still difficult to obtain satisfactory clinical results. Peripheral nerve regeneration following injury remains a significant challenge for researchers and clinicians. Exosomes are extracellular membranous nanovesicles that are secreted by most cells. As the key players of intercellular communication, exosomes play a fundamental role in the physiological and pathological processes of the nervous system. Accumulating evidence has suggested that exosomes can exert neurotherapeutic effects via mediating axonal regrowth, Schwann cell activation, vascular regeneration, and inflammatory regulation. Exosomes are emerging as a promising approach for treating peripheral nerve injury. Furthermore, they also provide possibilities for enhancing the repairing capacity of various nerve grafts. This review primarily highlights the regenerative effects of exosomes on peripheral nerve injury. The exosomes from distinct sources reported so far in the literature are summarized to understand their roles in the process of nerve repair. Moreover, the challenges that must be addressed in their clinical transformation are outlined as well. This review also provides further insight into the potential application of exosomes for peripheral nerve repair.     

肌电图仪在周围神经损伤手术中的临床应用

目的探讨肌电图仪在周围神经损伤手术中应用电刺激促进神经再生的监测作用。方法对23例周围神经损伤实施松解手术的患者于术中进行超强电刺激,在肌电图仪的持续监测下分析相应神经在刺激前后的电学变化。结果①电刺激后臂丛神经损伤和尺神经损伤复合肌肉动作电位的潜伏期较刺激前明显缩短,变化有统计学意义(P<0.05)。②电刺激后臂丛神经损伤、正中神经损伤、桡神经损伤的复合肌肉动作电位波幅明显高于刺激前,变化有统计意义(P<0.05)。结论肌电图仪在术中监测到对连续性尚存的损伤神经施行超强电刺激,能有效促进周围神经再生及神经功能恢复。     

新型神经吻合口制动动物模型的建立

目的 建立神经内制动实验动物模型,探讨周围神经损伤后机械牵拉力对神经再生的影响.方法 SD大鼠24只,随机分为实验组和对照组,每组12只.两组均建立神经损伤模型,实验组于坐骨神经远端套入硅胶导管,两端用医用粘合剂固定;对照组将坐骨神经断端吻合.评估实验组神经制动效果,观察两组术后8周神经电生理检测结果 及神经吻合口组织病理学.结果 实验组神经吻合口无位移,制动完全.术后8周实验组神经电生理检测潜伏期短于对照组,振幅高于对照组,神经吻合口周围结缔组织面积小于对照组,神经纤维再生数量多于对照组(P<0.05).结论 医用粘合剂、硅胶导管用于周围神经损伤后神经吻合口制动可促进神经纤维再生和动物模型的建立.     

Role of Immunity in Recovery from a Peripheral Nerve Injury

Motoneurons are large multipolar neurons with cell bodies located in the brainstem and spinal cord, and peripheral axons ending in neuromuscular junctions. Peripheral nerve damage, outside the blood-brain barrier (BBB), results in both retrograde changes centrally and anterograde changes along the length of the axon distal to the lesion site. Often, peripheral nerve damage is accompanied by motoneuron cell death, unless axon regrowth and target reconnection occur so that the target muscle can provide essential neurotrophic factors. It is essential that the motoneuron cell body survive during the process of reconnection so that the source for essential axon-rebuilding proteins is assure(of a fact)/ensured (results). A commonly used peripheral injury paradigm is that of facial nerve transection at its exit from the skull through the stylomastoid foramen so that nerve reconnection to the facial muscle tissue is permanently prevented. This model system allows for the study of the mechanisms responsible for maintaining facial motoneuron (FMN) cell body survival, without the complicating factor of axon regrowth. Injury to the nervous system results in an immune response that is either neuroprotective or neurodestructive. Findings suggest that FMN survival after facial nerve axotomy depends on the action of a CD4⁺ T cell that is initially activated peripherally and subsequently reactivated centrally. This review will summarize what is known about the neural-immune players involved in FMN survival and repair, so that the pharmacological manipulation of this interaction will one day become evident for the clinical management of neurological situations.     

肝细胞生长因子对周围神经再生的作用研究

目的：研究肝细胞生长因子（HGF）对周围神经再生的影响。方法：查阅有关献，综述HGF的结构以及在周围神经系统发育、损伤修复中的作用，并提出临床应用中的问题。结果：HGF在周围神经系统再生方面有一定的作用，但其作用机制、给药方式及途径有待进一步研究。结论：随着医学研究的进步，会增加HGF用于周围神经再生的临床治疗可能性。     

GM1对异种神经移植后再生和修复的研究

目的 :观察GM1 对异种神经移植后神经纤维再生和修复的效果。方法 :移植前将兔胫神经反复冻融处理。选大鼠30只 ,分GM1 组 (20只 ) :移植前将胫神经浸泡于0 1 %GM1 液中10min ;对照组 (10只 ) :未经任何处理 ,将兔胫神经移植于两组大鼠坐骨神经。术后第2、4、6、8和10周 ,将辣根过氧化物酶(HRP)注入大鼠坐骨神经吻合部远侧端。结果 :GM1 组术后第2周和第4周起分别在同侧L4～5脊神经节和腰段脊髓前角见到HRP标记细胞 ,而对照组从第4周和第6周起在同侧L4～5脊神经节和腰段脊髓前角见到标记细胞 ,术后动物不同存活期GM1组标记细胞数均明显多于对照组 (P<0 01) ,标记细胞数量随神经移植后存活期的延长而增加。术后10周有髓纤维再生率GM1 组明显高于对照组 (P<0 01)。结论 :GM1 可明显促进移植后神经纤维的再生和修复     

丁咯地尔治疗糖尿病周围神经病变的疗效

目的:观察盐酸丁咯地尔注射液治疗糖尿病周围神经病变的疗效。方法:糖尿病神经病变患者56例,随机分为两组。丁咯地尔组(n=28):盐酸丁咯地尔150 mg加入0.9%氯化钠注射液250 ml,ivd,qd。常规治疗组(n=28):采用常规治疗。疗程15 d,然后评价疗效和神经传导速度。结果:丁咯地尔组总有效率为96.5%,常规治疗组总有效率为57.1%,两组有统计学差异(P<0.05),丁咯地尔组神经传导速度明显提高(P<0.01)。结论:丁咯地尔治疗糖尿病周围神经病变疗效确切