【作者】 秦雅鑫；

【导师】 虞乐华；

【作者基本信息】 重庆医科大学 ， 康复医学， 2009， 硕士

【摘要】 背景:周围神经(Peripheral nerve)损伤是临床的多发病、常见病,是人类致残的重要原因之一。不同原因引起的周围神经损伤,其损伤程度不同,导致临床表现不同,治疗方法与预后也大不相同。治疗方法包括药物治疗、物理治疗、手术治疗与细胞治疗等,但功能恢复仍不够理想。因此,如何有效的促进周围神经损伤后的再生和功能恢复仍是临床工作关注的热点。物理治疗具有安全、无创、方便、有效等特点,日益受到临床医患的青睐。大量研究认为,脉冲电磁场具有增加骨密度、促进骨折愈合的作用,临床常运用于骨质疏松理疗。有零星报告脉冲电磁场也能促进受损周围神经的修复,但也有结果不支持的报道。因此,有必要进行相关实验研究,以明确其治疗的有效性与参数,并且探讨其作用机制,为拓展脉冲电磁场临床治疗周围神经损伤提供佐证。材料与方法:实验一按随机分组原则将SD大鼠30只分成5组:正常对照(A组);模型对照(B组); 0.3mT 2Hz (C组); 0.3mT 10Hz (D组); 0.3mT 40Hz (E组),每组6只。除正常对照组外,对所有大鼠按文献方法钳夹坐骨神经造模,造模成功后并定位标记。C、D、E组每天在强度为0.3mT,频率分别为2Hz、10Hz、40Hz的脉冲电磁场仪器中接受治疗,参考相关文献给予大鼠2h/次,2次/天,共30/d的治疗疗程,正常对照组与模型对照组不干预。测定坐骨神经功能指数(SFI)及神经传导速度(NCV),比较研究不同频率脉冲电磁场对大鼠坐骨神经损伤后功能恢复的影响。实验二30只SD大鼠随机分成三组:模型对照(A组)、正常对照(B组)和治疗(C组),每组10只。除正常对照组不处理外,其余组按实验一方法造模。治疗组给予合适频率(根据实验一结果)的脉冲电磁场治疗,2h/次,2次/天,模型对照组和正常对照组不给予任何干预。于1,2,4周除正常对照组外,对其余两组按随机抽样原则分别取5只大鼠,取其离钳夹伤5mm处的坐骨神经进行透射电镜观察,及免疫组化检测。并于第4周对模型对照组与治疗组轴突图象分析。结果:在强度与干预时间相同的前提下,0.3mT 2Hz组大鼠SFI及NCV显著高于其他频率组(P<0.05)。2Hz脉冲电磁场处理大鼠损伤坐骨神经后, Wallerian变性进程加速,雪旺氏细胞的增殖明显增加,髓鞘再生明显活跃,损伤坐骨神经中NGF表达显著高于模型对照组(P<0.05)。结论:0.3mT 2Hz组较10、40Hz组更能促进大鼠坐骨神经损伤后的功能恢复。在组织形态学上,脉冲电磁场能促进雪旺氏细胞的增殖,髓鞘增生;在分子生物学上,能促进NGF表达等,这可能是脉冲电磁场促进周围神经损伤后再生和功能恢复的机制之一。更多还原

【Abstract】 Background:Peripheral nerve injury is a common disease which is a major reason for disability in clinical. The clinical performance and prognosis are different because of different reasons. Treatment methods include medication、physical therapy、surgical therapy and cell therapy. However, the functional recovery is not ideal. It is also an outstanding issue for nerve injury repairing in the clinical. How to promote the regeneration and functional recovery after nerve injury becomes a focus.Physical therapy is safe、non-invasion、convenient and effective ,which is favored by the clinical. A large number of studies suggest that pulsed electromagnetic fields can increase bone mineral density, and promote the fracture healing. It is often used in treating the osteoporosis. What’s more, some reports said that pulsed electromagnetic fields can promote the peripheral nerve injury repairing, however, some do not support. Therefore, it is necessary to do the related experimental researches to make its effectiveness and the parameters clearly, also the mechanism. Providing the evidences in treating the peripheral nerve injury to realize the clinical values.Methods and materials:Experiment 1 According to the principle of randomized, 30 SD rats were divided into five groups: the normal control （group A）, model control （group B）, 0.3mT 2Hz （group C）, 0.3mT 10Hz （group D）, 0.3mT 40Hz （group E）, each 6. Except the normal control group, the other rats were clamped into sciatic nerve injury model according to the literature. After finishing the model, we gave them location. C、D、E group accepted the treatment , the PEMF’s field strength was 0.3mT, the frequency was 2Hz, 10Hz, 40Hz respectively. 2h/time, 2times/day, 30days altogether according the literature. the normal control group and model control group gave no intervention. Determined the sciatic nerve function index （SFI） and nerve conduction velocity（NCV） to all rats.Experiment 2 Select 30 SD rats, divided into 3 groups: model control（group A）、normal control （group B）and treatment （group C）, each 10. Except the normal control group, the other rats were received clamped sciatic nerve model according to the experiment 1. The treatment group were received 0.3mT 2Hz PEMF （according to the experiment 1’s result）,2h/time, 2times/day, model control group and normal control group were not given any treatment. Except the normal control group,we took 5 rats from the other two groups respectively,Then the nerves which was 5mm away from the clamped were sampled at the 1^st, 2^nd, 4^th week respectively, observed by electron microscope and immunohistoc-hemistry. Image pattern analysis of axon was done at the 4th week after operation to model control group and treatment group.Results:In the same strength and time, 2Hz group’s SFI and NCV were higher than other frequency groups significantly （P<0.05）. 2Hz PEMF make the course of Wallerian degeneration accelerated、schwann’s cell proliferation increased significantly、regeneration of axon improved obviously. The NGFof the treatment group expressed more than the model control group （P<0.05）.Conclusion:0.3mT 2Hz PEMF may be suitable for treating the sciatic nerve injury. one of the mechanism may be: PEMF accelerated the course of Wallerian degeneration,Schwann’s cell proliferation,regeneration of axon, and the expression of NGF in nerve’s fiber.更多还原