脊髓基质调节联合嗅鞘细胞移植治疗臂丛根性撕脱伤的研究

Roots avulsion injury is the most severe injury type of the brachial plexus lesions characterized by the interruption of rootlets from cervical cord，which could cause serious disability and is the most challenging world problem. The incidence rate has increased in recent years. Current surgical modalities are based on nerve transposition and functional reestablishment, but cause severe complications. In essence, this type of avulsion is considered to be a problem of the central nervous system(CNS). Therefore,the way of direct reimplantation of the avulsed rootlets into the spinal cord was explored to gain functional restoration,which has theoretic rationality and there were successful clinical case reports abroad. But so far, pure reimplantation has no obvious advantages compared with the traditional nerve transposition. In this study,we made the model of nerve rootlets avulsion injury.After X week,avulsed nerve roots were implanted into the spinal cord. At the same time,we also transplanted olfactory ensheathing cells and chondroitinase ABC into the corresponding spinal cord segment.Then we observe the fate of the OECs such as survival, migration, differentiation and we also estimatethe protective effect on motoneuron in the anterior horn of the spinal cord.It will provide the oretical foundation for further study, change traditional treatment mode and contribute to the unfortunate family and our society.

臂丛神经根性撕脱伤是神经损伤修复领域中最富有挑战性的世界难题，可造成严重伤残，且近年发病率有增加趋势.目前其治疗以周围神经水平的神经移位术及功能重建等为主，但常伴随严重并发症发生。 就其损伤本质而言，此损伤更应归属为中枢神经系统损伤的范畴.将撕脱的神经根回植入脊髓正是基于损伤本质，重建神经通路的连续性.因而存在理论上的合理性，且国外有成功临床病例报道。然而目前来看，单纯神经根回植术难以取得满意疗效，其总有效率与传统神经移位术相比无明显优势。本课题拟在大鼠臂丛撕脱伤及回植术模型中，同时采用髓鞘内嗅鞘细胞移植联合注射硫酸软骨素ABC，运用显微外科技术、电生理技术、免疫荧光技术等在不同时间点观察脊髓运动神经元的存活率，神经轴突生长状态与方向与上肢功能的改善状态。探讨增加神经根回植术有效率的方式， 以期为神经根性撕脱伤类创伤的有效治疗提供实验依据，改变传统治疗模式思维，为家庭和社会做出积极的贡献。

本课题在前期预实验中建立了经改良的大鼠臂丛根性撕脱伤模型，不仅保证了神经根撕脱的完全性及可靠性，而且提高了造模成功率，其损伤机制也更接近临床损伤特点；针对本课题联合治疗的干预特点，我们不仅观察嗅鞘细胞体外增值得规律，而且观察不同浓度的硫酸软骨素酶ABC对体外培养的嗅鞘细胞增值的影响，为体内实验奠定基础。针对臂丛神经根撕脱伤后脊髓持续长期的损伤放大效应及胶质瘢痕对神经再生影响，采取联合治疗的生物学干预策略（鞘内嗅鞘细胞移植及注射硫酸软骨素酶ABC）辅助神经根回植术治疗臂丛根性撕脱伤，发现该治疗策略可维持脊髓前角运动神经元的存活率，促进神经元再生；可促进外周神经功能的恢复及神经对靶肌肉的再支配并延缓肌萎缩，可改善肢体功能的恢复状况，有效提高了臂丛根性撕脱伤后神经根回植术的疗效。