神经干细胞移植延缓失神经肌萎的作用机制

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.     

色素沉着绒毛结节性滑膜炎致腕部尺神经卡压（附二例报告及文献综述）

色素沉着绒毛结节性滑膜炎致腕部尺神经卡压（附二例报告及文献综述）徐建光，胡韶楠，徐文东，顾玉东色素沉着绒毛结节性滑膜炎系一组发生于关节、四路与滑运的滑映特殊病变（临床上较少见），常见于联关节和踝关节．而发生在闭关节则甚为少见．近年，我院为２例因色素沉...     

内窥镜技术结合NAP早期判断尺神经缝合后再生质量的临床应用

目的介绍应用内窥镜技术结合测定神经干动作电位(nerve action potention，NAP)以早期判断肘部尺神经缝合后再生质量的新技术。方法对7例尺神经断伤后直接修复者，通过2个1．5cm长的切口，在内窥镜下行缝合神经的探查、松解术及功能性电刺激5～10min。测定神经松解术前后的NAP，比较其波幅及神经传导速度以判断神经的再生质量及手术效果。结果术中6例神经松解术前的NAP示有效神经再生，但经神经松解及功能性电刺激后尺神经缝合口远端的NAP波幅与神经传导速度比术前分别改善了30％和9．8％。1例患者神经缝合口瘢痕增生严重，且邻近肱动脉，改行开放性手术。结论内窥镜技术结合神经松解术前的NAP测定，可早期判断神经缝合后的再生质量。内窥镜下同时作神经粘连松解、功能性电刺激，结合神经松解后NAP的测定结果，证实该技术可提高尺神经修复后的治疗效果。     

器官移植中一氧化氮改变的特点

器官移植时一氧化氮生成增加并参与了排斥反应，影响到器官移植的成功。     

胸腔镜视下切取膈神经移位治疗臂丛神经损伤的临床应用报告

目的 首创在胸腔镜视下切断膈神经远端移接于肌皮神经的新术式。方法 临床应用５例。在胸腔镜视下于人膈肌近端切断膈神经,游离在胸腔内的膈神经全长。膈神经自锁骨上抽出经皮下引至肌皮神经３例,于锁骨下自第二肋间引起移位于肌皮神经２例。移接于肌皮神经主干２例,移接于肌皮神经肌支３例。首例于术后１１０ｄ,检测肱二头肥肥电图出现再生电位。结论 胸腔镜视下切并游离胸腔内膈神经全长,是膈神经移位术中切取膈神经的最佳     

电视胸腔镜胸段膈神经游离术

目的应用电视胸腔镜技术全程游离胸段膈神经用于膈神经移位修复臂丛神经损伤.方法从1999年8月至2000年7月,在12例臂丛神经损伤患者(男性11例,女性1例.年龄20～38岁,平均28岁.左侧损伤5例,右侧损伤7例.)中应用电视胸腔镜(Video assisted thoracic surgery,VATS)技术全程游离膈神经.手术中患者取平卧位,双腔气管插管全身麻醉以保证术侧肺萎陷.于第5肋间腋中线前约2 cm作小切口置Stryker 10 mm 0°胸腔镜,另于腋前线第3肋间及胸骨旁线外2 cm第2肋间作两个小切口置手术器械.采用两把普通长直角钳及内镜外科器械钝性及锐性分离膈神经及血管.结果12例均成功地在胸腔镜下完成膈神经的游离,其中3例同时游离伴行的心包膈血管.无手术相关并发症.全程游离后膈神经平均较传统颈部游离延长16 cm.结论采用电视胸腔镜游离膈神经移位治疗臂丛神经损伤是一种安全而微创的手术新方法.     

胸腔镜视下双侧胸交感神经干切断治疗原发性手汗症的临床分析

目的 总结在胸腔镜视下行双侧胸交感神经干切断术治疗手汗症的临床经验并分析其可行性.方法 2006年至2010年,在胸腔镜视下行双侧部分胸交感干切断术治疗手汗症23例.在胸腔镜视下电灼切断胸交感神经干(胸2～胸3),每3个月随访,以掌侧皮肤温度较术前升高1℃以上及干燥温暖为有效,手掌皮肤温度较术前增加小于1℃且仍潮湿者为无效.结果 23例患者术后手掌多汗症状立即消失,4例有背部或足底轻度代偿性出汗,无中度及以上代偿性多汗或其余严重并发症.术后随访时间为3个月至3年,平均18个月,无手汗复发,全部有效.结论 胸腔镜视下交感神经干切断术是一种治疗手汗症的安全有效的方法,且不难为手外科医师所掌握.     

应用几丁糖-胶原-二丙酸倍他米松缓释复合膜提高周围神经修复疗效的实验研究

目的:评价周围神经损伤后,神经吻合口局部应用几丁糖-胶原-二丙酸倍他米松缓释复合膜抑制疤痕增生、促进神经再生、提高神经功能恢复的作用.方法:成年雄性SD大鼠36只,胫神经切断术后随机分为3组,每组12只,A组仅给予单纯缝合,B组给予单纯缝合+吻合口包裹聚-DL-乳酸膜,C组给予单纯缝合+吻合口包裹几丁糖-胶原-二丙酸倍...     

四角融合术对桡腕关节内应力的影响

目的 比较四角融合前后桡腕关节内应力值、受力面积和平均压强的变化,研究四角融合术对桡腕关节内应力的影响.方法 8例新鲜正常腕关节标本通过夹具固定于支架上,将150 N负荷按比例加载于经过腕关节的各肌腱上,调节腕关节于不同位置,测量桡舟、桡月关节内的应力大小、受力面积和平均压强,测量结束后对标本行四角融合术,以同样方法进行测量,比较四角融合前后数据,分析四角融合对桡腕关节的影响.结果 正常时,桡舟关节内受力面积占其关节面的3%～43%,桡月关节为6%～30%;四角融合后,桡舟关节为0%～30%,桡月关节为7%～32%.正常时和四角融合后,桡腕关节内的应力值、受力面积和平均压强随腕关节位置的变化而呈现相似的变化趋势,但正常时应力柔和渐变,四角融合后明显剧烈而僵硬.结论 正常桡舟、桡月关节内有各自独立的应力承受区,其面积不等于实际的关节面积,根据腕关节的位置不同而有变化;四角融合后桡腕关节内的应力变化较正常时剧烈、僵硬,长期作用可能使腕关节内软骨发生退行性变化.     

神经干细胞移植延缓失神经肌萎的作用机制

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.