【作者】 姜俊杰；

【导师】 王守彪； 夏玉军；

【作者基本信息】 青岛大学 ， 临床应用解剖学， 2003， 硕士

【摘要】 目的：通过切断及切断后再修复坐骨神经，观察在其相应脊髓节段中Nogo-A表达的变化规律，了解在周围神经损伤及修复过程中相应中枢部位Nogo-A的作用规律，为合理的选择周围神经损伤的修复方法和修复时间，有效避免Nogo-A对周围神经损伤修复的影响提供基础理论依据。 方法：选用健康Sprague Dawley(SD)大鼠150只，体重约200克，雌雄不拘，按照实验目的随机分为6组，每组25只。第一组：切断坐骨神经。第二组：切断坐骨神经，随即在手术显微镜下用10／0无创伤缝合线缝合神经外膜以修复切断的坐骨神经。第三组：切除坐骨神经1cm。第四组：切除坐骨神经1cm，随即用第三组切除之坐骨神经行同种异体神经移植。第五组：切除坐骨神经1cm，随即将切除之坐骨神经原位缝合神经外膜修复坐骨神经，模拟自体神经移植。第六组(假手术对照组)：参照以上各组手术方法显露坐骨神经但不损伤。以上各组大鼠术后每一组随机分为5组，每组5只，分别于术后24小时、48小时、1周、2周、32天处死。经左心室—升主动脉插管灌注固定，然后迅速取出相应节段脊髓，将取出的脊髓多聚甲醛固定、脱水、浸蜡、包埋、切片、免疫组织化学处理，光镜观察，并对脊髓前角运动神经元行光密度测定。 结果：光镜下可见，Nogo-A在脊髓前角运动神经元胞浆内有明显 坐骨神经损伤后Nog，A在相应脊翻节段的表达表达，而细胞核内未见表达。平均光密度测定显示，坐骨神经切断、切除、切除后自体神经移植组及异体神经移植组脊髓灰质前角坐骨神经损伤侧Nogo一A表达阳性的运动神经元平均光密度较未损伤侧明显增高。其中，坐骨神经切断、切除及切除后自体神经移植组，相应损伤侧脊髓前角Nogo一A表达阳性的运动神经元平均光密度增强的规律基本相似，于伤后1、2天即出现增高，l周时达高峰，之后逐渐降低，32天时趋向正常。坐骨神经切断后立即修复组，相应损伤侧脊髓前角Nogo一A表达阳性的运动神经元平均光密度较未损伤侧无明显增强，且各观察时间点平均光密度无明显差别、而坐骨神经切除后行异体神经移植组，术后第1、2天相应损伤侧脊髓前角Nog。一A表达阳性的运动神经元平均光密度即较未损伤侧明显增高，1周时增高幅度减小，2周时达高峰，后虽逐渐降低，但至32天时仍处于较高水平。 结论:坐骨神经损伤后，脊髓相应节段损伤侧前角运动神经元胞浆内Nogo一A的表达较未损伤侧明显增强。伤后立即行端一端吻合术修复，脊髓相应节段损伤侧前角运动神经元胞浆内Nog。一A的表达基本正常，无明显表达增强改变。伤后立即行自体神经移植术，脊髓相应节段损伤侧前角运动神经元胞浆内Nogo一A的表达变化规律与不治疗组相同;而立即行异体神经移植术，早期即可加重Nogo一A表达的增强，在术后32天Nogo一A表达的增强仍维持于较高水平。更多还原

【Abstract】 Objectives: To investigate the regularity of the expression of Nogo-A in spinal cord corresponding to traumatic sciatic nerve in the course of injury and repair.Methods: 150 healthy adult Sprague Dawley(SD)rats were randomly divided into 6 groups, 25 per group. Group 1: sciatic nerves were severed without repair; Group 2: sciatic nerves were cut followed by immediate anastomosis of nerval adventitia using 10/0 non-traumatic suture; Group 3: 1 cm of sciatic nerve was resected in every subjects; Group 4: 1 cm resection of sciatic nerve was replaced by the resected sciatic nerve in group 3; Group 5: 1 cm of sciatic nerve was severed followed by epineurial suture in situ; Group 6: Visualization of sciatic nerve was performed without injury to it. The rats of each group were randomly divided into 5 subgroups, 5 per subgroup. The five subgroups were sacrificed at different intervals, 1 day, 2 day, 1 week, 2 week, 32day after operation. The expression of Nogo-A in spinal cord were detected by immunohistochemical staining and quantified by mean optical density (MOD).Results: The expression of Nogo-A was positive in the cytochylema of motoneuron in anterior gray column of spinal cord. The MOD of traumatic side was evidently higher than non-traumatic side in group 1, 3, 5 at 1, 2 day after operation. The MOD of the severed side reached the top at 1 week.and then descented gradually, and almost normal at 32days after operation. The MOD of traumatic side was not statistically different from non-traumatic side in the group 2. The MOD of traumatic side raised remarkable at 1 ,2 day after operation in the group of altogeneic transplantation, descented a little at 1 week, reach top at 2 week and maintained high level afterwards.Conclusions: The expression of Nogo-A in motoneuron on traumatic side was higher than that on non-traumatic side. The expression of Nogo-A in traumatic side was different from non-traumatic side and came to normal on the condition that the traumatic nerve was immediately repaired by end-end anastomosis after injury. If the the traumatic nerve was replaced by allogeneic transplantation, the expression of Nogo-A in traumatic side were remarkable higher than that in non-traumatic side, and still maintained high level even after 1 month.更多还原