【作者】 魏树刚；

【导师】 郑修启；

【作者基本信息】 泰山医学院 ， 外科学， 2011， 硕士

【摘要】 目的:观察晚期脊髓损伤患者嗅鞘细胞移植术后交感神经皮肤反应的波幅、潜伏期的变化及感觉、运动ASIA评分变化,分析其术后疗效及价值。方法:①对象:自2010年1月至2010年12月收治的43例晚期脊髓损伤患者(病史>6个月),男39例,女4例,平均年龄(30.7±10.3)岁,平均病程(4.7±3.5)年;完全性17例,不完全性26例,受伤节段:C1-813例,T1-10 14例,T11及以下16例;受伤原因:车祸、摔伤、砸伤。双下肢均有不同程度的出汗减少,皮肤颜色灰暗,脱屑症状。②嗅鞘细胞的培养及鉴定:选择4～6个月中期引产胚胎(水囊引产),对其嗅球剥膜后机械性剪碎,然后培养消化细胞并制成单细胞悬液,浓度为1×1010 L-1左右,其纯度在96%左右。嗅鞘细胞免疫组织化学染色,表现为p75抗体阳性。③嗅鞘细胞移植手术:术前脊髓病变部位MRI检查,根据具体的脊髓损伤情况,准确进行定位。手术采用后正中入路,要把准确定位的损伤节段的棘突和椎板咬除,打开硬脊膜,暴露损伤部位的脊髓,在显微镜下,把嗅鞘细胞悬液多点注入脊髓病变部位上下端,和正常脊髓交界的部位,数量约约100μL,细胞数约1×106个嗅鞘细胞,关闭切口。未用免疫抑制剂。④功能评定:在相同的条件下术前1天和术后2周行SSR检测及ASIA运动、感觉进行评分,比较前后的变化。结果:所有患者术后2周其下肢运动、感觉、植物神经功能均有不同程度的改善,植物神经功能改善表现为皮肤均有不同程度出汗增加,颜色好转,脱屑减少。SSR测定术后其潜伏期及波幅优于手术前,其术后运动感觉ASIA评分都有明显提高.结论:晚期脊髓损伤患者通过嗅鞘细胞移植治疗,其神经功能都有不同程度改善,包括运动、感觉及植物神经功能,运动感觉可以通过ASIA功能表评价,SSR检测能较为客观的反映脊髓术后交感神经功能恢复情况,尤其是出汗的变化,可以作为ASIA功能评价的补充,对脊髓植物神经功能进行评价,能更准确全面地反映细胞移植后脊髓神经功能的变化。更多还原

【Abstract】 Objective:To Observe in patients with advanced spinal cord injury after transplantation of olfactory ensheathing cells of sympathetic skin response latency changes and amplitude changes in ASIA scores, analysis and value of its after effects.Method:①: PARTICIPANTS: 43 patients with advanced spinal cord injury patients, 36 males and 4 females, mean age (30.7±10.3) years, mean disease duration (4.7±3.5) years; complete in 17 cases, 26 incomplete cases, injury segments: cervical 13 cases, 14 cases of thoracic and lumbar 16; cause of injury: car accidents, falls, injured. preoperative can lead to SSR. of both lower extremities to reduce sweating in varying degrees, dark skin color, scaling symptoms.②Cell culture and identification: Take 4 to 6 months embryo induction medium (through the Hospital Ethics Committee approval) of the olfactory bulb, after stripping membrane mechanical manipulation, cultured in the presence of 10% -15% fetal calf serum D/F-12 Training liquid (GIBICO products) in, 3d after the purification of serum-free DMEM culture medium was changed every 3d semi-liquid 1, continue to develop 7-10 d. Digestive cells and made into single cell suspension, the cell concentration of 1×1010L-1 or so. The purified p75 antibodies in cultured cells selected for immunohistochemical staining, positive for olfactory ensheathing cells, the purity of 95% to 98%.③Surgery and cell transplantation: preoperative routine MRI, according to MRI to determine the site of spinal cord lesions. Segmental lesions anesthesia after midline approach to remove the spinous process and lamina of the lesion, dura cut to expose the spinal cord. With the operating microscope in the spinal cord and spinal cord lesions at the junction of the normal part of multi-point injection disposal of approximately 100μL suspension of olfactory ensheathing cells, about 1×106个olfactory ensheathing cells, tightly close the dura mater and suture layers. Given after surgery to stop bleeding, anti-infection treatment④Functional evaluation: the same conditions in the downstream SSR detection, using ASIA motor and sensory table rate before and after surgery were compared before and after the change.Results:All patients after 2 weeks of their lower limb motor, sensory, autonomic function were improved to some extent, improve the performance of autonomic function in varying degrees of skin increased sweating, color improvement, scaling reduced. SSR latency and amplitude measured after its better than before surgery, the incubation period amplitude .The spinal cord motor and sensory function after surgery have significantly improved scores .Conclusion:Olfactory ensheathing cell transplantation for the treatment of spinal cord injury patients, the patients had improved motor and sensory autonomic functions, SSR detection can be more objectively reflect autonomic functional recovery after spinal cord can be used as supplementary ASIA functional assessment of the spinal cord Evaluation of autonomic function. More accurate and comprehensive reflection of cell transplantation for spinal cord nerve function changes.更多还原