部分去背根猫备用背根节和脊髓Ⅱ板层NT-3及其mRNA的表达变化

采用免疫组化和原位杂交技术探讨了部分去背根猫备用背根节 (L6 )和 L3、L5脊髓 II板层 NT-3及其 m RNA的表达变化。结果发现 ,正常组 NT-3及其 m RNA阳性产物主要分布于背根节的大型神经元和少数中、小型神经元。部分去背根后 ,3 d和10 d两时相 NT-3 m RNA大型神经元阳性数明显减少 ,而 NT-3阳性大型神经元数术后 10 d时方明显减少 (P<0 .0 1) ;NT-3及其 m RNA阳性小型细胞数在术后两时相均较正常组者增多 (P<0 .0 1) ;而在中型神经元只有 NT-3阳性神经元数有增加。相对地 ,在脊髓 板层 ,两时相 NT-3阳性神经元及胶质细胞百分数均较正常者明显增加 (P<0 .0 1) ,且以 3 d组者为最明显 ,但均未见 NT-3 m RNA阳性信号。结果表明 ,部分去背根不仅导致背根节各类神经元中 NT-3的表达发生了变化 ,且对 板层 NT-3阳性神经元及胶质细胞数量也有明显影响。提示 NT-3可能在脊髓 板层可塑性中发挥作用     

部分背根切断对备用背根节NT-3表达的影响

目的　探讨部分去背根后备用背根节 (L6 )各类细胞NT 3及其mRNA的含量变化。　方法　对成年雄性猫行单侧部分背根切断术 (切除一侧L1 ～L5,L7～S2 DRG ,保留L6 为备用根 )。取正常组一侧和术后 3d及 7d组手术侧的L6 DRG制作 2 0 μm厚冰冻切片 ,分别用NT 3抗体及NT 3cRNA探针行免疫组织化学及原位杂交染色。观察NT 3及其mRNA在DRG各类细胞的分布 ,测定NT 3及其mRNA在神经元和卫星细胞的光密度值 ,所得数据用q检验进行统计分析。　结果　部分去背根后 ,各时相备用背根节大神经元内NT 3的光密度值较正常者进行性减少 ,(P <0 0 5 ) ,而NT 3mRNA的光密度值术后 3d减少 ,7d回升至近正常者水平。比较之 ,小神经元和卫星细胞NT 3及其mRNA的光密度值进行性增多 (P <0 0 5 )。　结论　部分背根切断对备用背根节各类细胞NT 3表达的影响不同 ,其功能意义可能与NT 3参与脊髓Ⅱ板层可塑性有关     

三叉神经半月节射频热凝术不同定位方法比较

目的 探讨三种不同定位方法在三叉神经半月节射频热凝术中的治疗效果及优缺点.方法 155例患者根据定位方法的不同分为A、B、C三组,A组为CT定位下徒手穿刺卵圆孔组,B组为立体定向CT引导下穿刺卵圆孔组,C组为立体定向CT-MR图像融合直接定位半月神经节组.分别对三组患者术中情况、手术并发症、疗效及预后进行比较.结果 A组一次性穿刺成功率33.87%,显著低于B组（92.98%）、C组（100%）;术中心血管反应发生率A组48.39%,显著高于B组（14.04%）、C组（8.33%）;手术时间A组亦显著长于B、C组.手术并发症方面A组发生率33.87%,B组21.05%,C组16.67%,三组间无显著性差异,主要为面部感觉减退,其他并发症A组显著高于B、C组.预后优良率A组80.65%,显著低于B组（94.74%）、C组（100%）,术后复发率A组11.29%,显著高于B组（1.75%）、C组（0%）.结论 CT定位下徒手穿刺卵圆孔操作方法简单,但穿刺存在较大肓目性,术中患者痛苦较大,心血管反应发生率高,手术时间延长,术后并发症相对较多,术后复发率偏高.立体定向CT引导下穿刺卵圆孔定位准确,术中患者痛苦较小,术后并发症少,复发率低,但仍为间接定位方法,不能直接定位半月神经节,如患者存在卵圆孔变异则手术难度较大.立体定向图像融合技术直接精确定位三叉神经半月节及穿刺路径,消除了穿刺盲区,显著提高了穿刺的准确性和治疗效果.     

A comparative histological analysis of two models of nerve root avulsion injury in the adult rat

D. J. Chew, T. Carlstedt and P. J Shortland (2011) Neuropathology and Applied Neurobiology 37, 613–632 A comparative histological analysis of two models of nerve root avulsion injury in the adult rat Aims: This study has investigated the reliability of the artificial surgical model dorsal root rhizotomy (DRR), to the surgical tearing of the roots, avulsion, that occurs clinically. Root avulsion of the limb nerves is common in high‐impact motor vehicle accidents and results in paraesthesia, paralysis and intractable pain. Limited treatment options are largely due to a lack of basic research on underlying mechanisms, and few animal models. We assess this limitation by histologically assessing the spatial and temporal injury profile of dorsal root avulsion (DRA) and DRR within the spinal cord. Methods: Rats underwent DRR, DRA or sham surgery to the L3–L6 dorsal roots unilaterally. At 1, 2, 14, and 28 days post injury, immunohistochemical density staining was used to characterize the progression of spinal cord trauma. Neuronal (NeuN) and vascular degeneration (RECA‐1), inflammatory infiltrate (ED1, anti‐neutrophil), gliosis (Iba1, GFAP) and apoptosis (TUNEL) were assessed. Results: Unilateral DRA produced a prolonged and bilateral glial and inflammatory response, and vascular degeneration compared to transient and unilateral effects after DRR. Transsynaptic neurodegeneration after DRA was greater than after DRR, and progressed across 28 days coinciding with gliosis and macrophage infiltration. Conclusions: Rhizotomy leads to a milder representation of the spinal cord trauma that occurs after ‘true’ avulsion injury. We recommend DRA be used in the future to more reliably model clinical avulsion injury. Avulsion is an injury with a chronic profile of degenerative and inflammatory progression, and this theoretically provides a window of clinical therapeutic opportunity in treatment of secondary trauma progression.     

选择性腰5、骶1脊神经后根切断术加内收肌切断术治疗下肢痉挛的研究

采用选择性腰 5、骶 1脊神经后根切断术 内收肌切断术治疗成人脑外伤后、脑瘫、脊髓损伤后下肢痉挛 2 9例 ,术前术后进行步态分析。术前 3天进行步态分析 ,术中于大腿内侧将内收肌腱性部分切断松解内收肌 ,将痉挛下肢的腰 5、骶 1的脊神经后根进行分束 ,电刺激仪测阈值后将阈值较低的神经束切断。2 9例随访 3年 ,痉挛解除率 90 %,功能改善率 80 %。术后步态与术前比较有明显改善。说明选择性腰 5、骶 1脊神经后根切断术 内收肌切断术能较有效的治疗成人脑外伤后、脑瘫、脊髓损伤后肢体痉挛。     

肛门括约肌肌电图监测下双侧L2～S2选择性脊神经后根切断术治疗痉挛性脑瘫

目的为提高手术安全性,在L2～S2选择性脊神经后根切断(SPR)手术时,对肛门括约肌进行肌电图(EMG)监测,并评价其作用。方法在SPR手术监测中,当对S2后根小束进行电刺激时,采用针状电极记录双侧肛门括约肌的反应情况,有明显反应的后根小束予以保留。手术后随访患者踝痉挛改善情况和括约肌功能变化情况。结果所有患者手术后踝痉挛均有明显改善,无大小便功能障碍发生。结论SPR手术包括S2后根时,术中括约肌EMG监测对保证疗效,保护括约肌功能,提高手术安全,具有重要意义。     

选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛的临床观察

目的探讨选择性腰骶段脊神经后根部分切断术(SPR)治疗脑瘫性下肢痉挛的疗效。方法回顾性分析406例脑瘫性下肢痉挛病人的临床资料,均行SPR治疗和康复训练,并采用相应量表评估病人临床症状的缓解情况。结果 406例获随访6～36个月,平均28.8个月。随访期间,痉挛状态缓解378例(93.3%),维持术前水平28例(6.7%);肌张力缓解362例(89.2%),维持术前水平44例(10.8%);步态功能改善370例(91.3%),维持术前水平36例(8.7%);生活质量提高378例(93.3%),无明显改善28例(6.7%)。术后发生下肢感觉障碍54例(13.3%),肌力下降72例(17.7%),一过性尿潴留9例(2.2%),一过性体温升高31例(7.6%)。结论 SPR治疗脑瘫性下肢痉挛的疗效确切、创伤小、并发症少,严格掌握适应证且术后坚持长期正规康复训练是保证疗效的关键。     

Distribution of RET immunoreactivity in the rodent spinal cord and changes after nerve injury

RET (for “rearranged during transfection”) is a transmembrane tyrosine kinase signaling receptor for members of the glial cell line‐derived neurotrophic factor (GDNF) family of ligands. We used RET immunohistochemistry (IHC), double‐labeling immunofluorescence (IF), and in situ hybridization (ISH) in adult naïve and nerve‐injured rats to study the distribution of RET in the spinal cord. In the dorsal horn, strong RET‐immunoreactive (‐ir) fibers were abundant in lamina II‐inner (II_i), although this labeling was preferentially observed after an antigen‐unmasking procedure. After dorsal rhizotomy, RET‐ir fibers in lamina II_i completely disappeared from the dorsal horn, indicating that they were all primary afferents. After peripheral axotomy, RET‐ir in primary afferents decreased in lamina II_i and appeared to increase slightly in laminae III and IV. RET‐ir was also observed in neurons and dendrites throughout the dorsal horn. Some RET‐ir neurons in lamina I had the morphological appearance of nociceptive projection neurons, which was confirmed by the finding that 53% of RET‐ir neurons in lamina I colocalized with neurokinin‐1. GDNF‐ir terminals were in close proximity to RET‐ir neurons in the superficial dorsal horn. In the ventral horn, RET‐ir was strongly expressed by motoneurons, with the strongest staining in small, presumably γ‐motoneurons. Increased RET expression following peripheral axotomy was most pronounced in α‐motoneurons. The expression and regulation pattern of RET in the spinal cord are in line with its involvement in regenerative processes following nerve injury. The presence of RET in dorsal horn neurons, including nociceptive projection neurons, suggests that RET also has a role in signal transduction at the spinal level. This role may include mediating the effects of GDNF released from nociceptive afferent fibers. J. Comp. Neurol. 500:1136–1153, 2007. © 2006 Wiley‐Liss, Inc.