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.     

应用人骨形态发生蛋白治疗舟骨骨不连

骨形态发生蛋白(BMP)在骨的发育和骨折愈合过程中均起着重要的作用,它可刺激间充质干细胞分化为成软骨细胞或(和)成骨细胞,并最终通过一系列级联反应导致新骨的形成。动物实验证明BMP可诱导异常部位的骨化,并可用于复杂骨缺损的治疗。舟骨骨折骨不连的治疗是手外科最棘手的难题之一,该文报道应     

自制简易外固定牵引支架结合克氏针固定治疗近中节指骨干粉碎性骨折

目的：探讨应用自制简易外固定牵引支架结合克氏针固定治疗近、中节指骨干粉碎性骨折的方法和疗效。方法2009年6月-2013年8月,对26例（32处）近、中节指骨粉碎性骨折患者采用自制简易外固定牵引支架结合克氏针及可吸收线固定治疗,并定期随访,观察疗效。结果术后所有病例骨折均愈合,无骨髓炎发生,未出现骨折移位或畸形愈合,有9处骨折在愈合过程中形成外骨痂。按照手指总主动活动度（tatol active motion, TAM）的评级标准并参考手指总主动屈曲度（tatol active flexion, TAF）的评分标准,评定患指运动功能,优5例（5处）,良16例（17处）,可3例（6处）,差2例（4处）;病例优良率80．8％（骨折部位优良率68．8％）。结论应用自制简易外固定牵引支架结合有限内固定治疗近、中节指骨粉碎性骨折方法可靠,手术创伤小,能有效固定骨折,早期进行功能锻炼,恢复手指的运动功能。     

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.     

神经干细胞移植延缓失神经肌萎的作用机制

目的 研究脊髓神经干细胞移植到外周神经后延缓失神经肌萎的作用及机制.方法 取孕10～12 d的SD孕鼠,提取、培养及纯化脊髓神经干细胞,传2～3代后,将分散成单细胞的神经干细胞(106/μl×5μl)移植到胫神经切断模型的远端;设立对照组,移植5μl干细胞培养液.术后分别于3、5个月取材,观察移植神经干细胞的分化;比较干细胞移植能否延缓失神经肌萎;观察靶肌肉中突触(神经肌肉接头)的变化情况.结果 移植后3、5个月,发现移植组小腿三头肌萎缩较对照组减轻(P<0.05);移植组中的突触后膜退变萎缩明显好于对照组,术后5个月出现了新的突触结构.结论 神经干细胞移植可以延缓失神经肌萎的程度,有效保护失神经肌肉突触后膜的结构,并能形成新的突触.     

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.     

肘部单切口下二氧化碳灌注内窥镜辅助下尺神经松解及前置术

目的 介绍一种在单个小切口下利用二氧化碳(CO2)气泵于肘部尺神经行经处创造气腔,在内窥镜辅助下彻底松解尺神经并前置的方法.方法 2005年至2008年,对12例临床确诊为肘管综合征的患者在肘内侧做单个纵行小切口,利用气腹机在肘部皮下与前臂或臂部深筋膜之间产生的CO2气腔内,采用℃角内窥镜下行尺神经松解及屈肌筋膜下前置术.采用Dellon及改良Bishop评分系统进行手术前后评估.结果 术前根据Dellon评分,12例肘管综合征中轻度5例、中度5例、重度2例.肘部手术切口长(15±3)mm,CO2气腔均成功建立,尺神经松解长度为(18±2)cm,内窥镜下的神经松解及筋膜下前置手术均顺利,整个手术持续时间为(30±5)min.术后所有患者的尺神经症状均较术前有改善,无并发症发生.随访时间为12～18个月,按改良Bishop 评分:优10例(占83.3％),良2例(占16.7％).结论 肘部单个小切口下,CO2灌注产生的皮下气腔可以更好地暴露尺神经,结合内窥镜肘部尺神经松解及前置术减少了对神经分支及血供的损伤.该方法简单安全,创伤小,恢复快.     

急性舟骨骨折的诊断和治疗

舟骨骨折是腕部最常见的骨折,其漏诊、误诊率高,晚期并发症多,早期正确的诊断和及时恰当的治疗对于减少这些并发症的发生至关重要。该文就近年来急性舟骨骨折的诊断和治疗进展作一文献回顾。     

肱骨髁上骨折伴桡神经损伤41例的手术治疗

目的探讨儿童肱骨髁上骨折伴桡神经损伤的手术治疗效果。方法通过回顾性分析上海市儿童医院收治的儿童肱骨髁上骨折伴桡神经损伤的患儿41例的临床资料,将其分为2组。研究组为肱骨髁上骨折切开复位并行Ⅰ期神经探查修复;对照组为肱骨髁上骨折外院处理骨折愈合后伴神经损伤,术后2～4个月至本院进行Ⅱ期神经探查修复。对2组患儿在神经修复治疗后功能恢复情况进行分析。结果研究组18例中疗效优13例、良4例、一般1例,优良率为94.44%;对照组23例中疗效优6例、良12例、一般3例、差2例,优良率仅为78.26%。Ⅰ期手术患儿桡神经功能恢复优良率要优于Ⅱ期手术患儿(P=0.028)。结论儿童肱骨髁上骨折伴桡神经损伤,Ⅰ期处理骨折的同时积极处理损伤的桡神经,能取得满意疗效。     

035.应用人骨形态发生蛋白治疗舟骨骨不连

畸形愈合是桡骨远端骨折的常见并发症之一，其破坏了桡远关节面的平整性和各关节之间的力学关系，往往造成后期腕部的运动障碍或疼痛。截骨矫形术是治疗桡骨远端骨折畸形愈合的常用术式，但是迄今为止，该术式主要运用于矫正畸形愈合的关节外桡骨远端骨折，鲜见有其运用于关节内骨折畸形愈合的报道。该文作者利用小切口、微型钢板或螺钉对23例成人关节内桡骨远端骨折进行了截骨矫形。