ObjectiveTo investigate the effects of the first neuron connection for the reconstruction of lower extremity function of complete spinal cord injury rats. MethodsForty adult female Sprague Dawley rats of 300-350 g in weight were selected to prepare the models of L1 transverse spinal cord injury. After 2 weeks of establishing model, the rats were randomly divided into control group (n=20) and experimental group (n=20). In the experimental group, the right hind limb function was reconstructed directly by the first neuron; in the control group, the other treatments were the same to the experimental group except that the distal tibial nerve and the proximal femoral nerve were not sutured. The recovery of motor function of lower extremity was observed by the Basso-Beattie-Bresnahan (BBB) scoring system on bilateral hind limbs at 7, 30, 50, and 70 days after operation. The changes of the spinal cord were observed by HE staining, neurofilament 200 immunohistochemistry staining, and the technique of horseradish peroxidase (HRP) tracing. ResultsAfter establishing models, 6 rats died. The right hind limb had no obvious recovery of the motor function, with the BBB score of 0 in 2 groups; the left hind limb motor function was recovered in different degrees, and there was no significant difference in BBB score between 2 groups (P>0.05). In the experimental group, HE staining showed that the spinal cord was reconstructed with the sciatic nerve, which was embedded in the spinal cord, and the sciatic nerve membrane was clearly identified, and there was no obvious atrophy in the connecting part of the spinal cord. In the experimental group, the expression of nerve fiber was stained with immunohistochemistry, and the axons of the spinal cord were positively by stained and the peripheral nerve was connected with the spinal cord. HRP labelled synapses were detected by HRP retrograde tracing in the experimental group, while there was no HRP labelled synapse in the control group. ConclusionDirect reconstruction of the first neurons is sufficient in the regeneration of corresponding neural circuit by the growth of residual axon; but the motor function recovery of the target muscles innervated by peripheral nerve is not observed.
Since Ⅰ982, Twenty-five cases of birth injuries of brachial plexus have been treated by microsurgical technipue. The satisfactory result has been obtained. The excellent and good rate are 76 per cent. The operative method included endoneurolysis, anastomosis of nerve, supraclavicular nerve grafting and transposition of phrenic nerve, accessory nerve and cervix motor nerve. In this article, the early diagnosis and differentiel diagnosis, practical physical examination method, and operative technipue were descused.
Objective o study the feasibility of homologous vascularized nerve transplantation after ultra deep cryopreservation. Methods Vascularized sciatic nerve from 12 female dogs was transplanted after ultra deep cryopreservation. Fortyeight male dogs were divided into 4 groups: ultra deep cryopreservation homologous vascularized nerve (group A), ultra deep cryopreservation homologous nerve (group B), fresh homologous vascularized nerve (group C), and fresh autologous vascularized nerve (group D). The gross appearance, patency rate of arteryand morphological transplanted nerve were observed 1, 4 and 12 weeks after transplantation respectively. Immunological analysis was performed using IL 2 assay and T lymphocyte subpopulations assay after 4 weeks. Image pattern analysis andelectromyogram were observed after 12 weeks. Results In groups A and D, no toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were restore significantly in the postoperative 12th week. In groups B and C, toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were not restored significantly in the postoperative 12thweek. The vessel patency rate of groups A and D was 83.3%, which was significantly higher than that of group C (50%,Plt;0.05). The changes of IL2 and Th, Ts in group C were significantly higher than that in groups A,B,D(Plt;0.01). There were increased vessel and regenerated nerve in transplanted nerve under optical microscope and image pattern analysis in groups A and D. There were shorter latent period of motor evoked potential, greater amplitude of action potenlial and faster motor nerve conducting velocity in groups A and D after 12 weeks. Conclusion The antigenicity of the homologous never and vessel may be reduced significantly by being frozen, and cryopreserved vascularized nerve can transferred successfully without the use of immunosuppressive agents. Vascularized nerve may restore good significantly for the thick nerve.
The sciatic nerves of adult rats were sectioned bilaterally and the ends of the nerves were placed in silicone tubes. One side of the distal nerve segment was inverted and that of the contralateral side was non-inverted. After 2, 4, 6 weeks, the rats were killed and the specimens were removed for macroscopic, histologic and morphometric analysis. The results showed that either the inverted or non-inverted distal nerve segments had no influence on the number of the myelinated axons in the regenerated nerves, but the number and density of the myelinated axons was markedly diminished in the inverted distal nerve segments.
Objective To make a comparison between the effects of the small intestinal submucosa (SIS) graft and the insideout vein graft on repairing the peripheral nerve defects. Methods SIS was harvested from the fresh jejunum of the quarantined pig by curetting the musoca, the tunica serosa, and the myometrium; then, SIS was sterilized, dried and frozen before use. Thirty-six male SD rats were divided into 3 groups randomly, with 12 rats in each group. Firstly, the 10mm defects in the right sciatic nerves were madein the rats and were respectively repaired with the SIS graft (Group A), the insideout autologous vein graft (Group B), and the autonerve graft (Group C). At 6 weeks and 12 weeks after the operations, the right sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by the histological examination, the neural electrophysiological examination, the computerized imaging analysis, and the Trueblue retrograde fluorescence trace. Results The histological examination showed that the regenerated nerve fibers were seen across the defects in the three groups at 6 weeks after the operations. The nerve fibers were denser, the formed nerve myelin was more regular, and the fibrous tissue was less in Group A than in Group B; the nerve regeneration was more similar between Group A and Group C. At 12 weeks after the operations, the neural electrophysiological examination showed that the neural conductive rate was significantly lower in Group B than in Groups A and C (Plt;0.05),but no statistically significant difference was found between Group A and GroupC (Pgt;0.05); the component potential wave amplitude was not statistically different between Group A and Group B; however, the amplitude was significantly lower in Groups A and B than in Group C (Plt;0.05). At 6 weeks and 12 weeks after the operations, the computerized imaging analyses showed that the axiscylinder quantity per area and the nerve-tissue percentage were significantly greaterin Group A than in Group B (Plt;0.05); the average diameter of the regenerated axis cylinder, the axiscylinder quantity per area, and the nerve-tissue percentage were significantly lesser in Group B than in Group C (Plt;0.05). At 12 weeks after the operations, the Trueblue retrograde fluorescence trace revealed that the positivelylabeled neurons were found in the lumbar 3-6 dorsal root ganglion sections in the three groups. Conclusion The small intestinal submucosa graft is superior to the autologous inside-out vein graft in repairing the peripheral nerve defects and it is close to the autonerve graft in bridging the peripheral nerve defects. Therefore, the small intestinal submucosa is a promising biological material used to replace the autonerve graft.
ObjectiveTo review and analyze the long-term results of delayed repair of median nerve injury. MethodsBetween January 2004 and December 2008, 228 patients with median nerve injury undergoing delayed repair were followed up for more than 4 years, and the clinical data were retrospectively analyzed. There were 176 males (77.19%) and 52 females (22.81%), aged 2-71 years (median, 29 years). The main injury reason was cutting injury in 159 cases (69.74%);203 cases had open injury (89.04%). According to the injury level, injury located at area I (upper arm) in 38 cases (16.67%), at area II (elbow and proximal forearm) in 53 cases (23.25%), at area III (anterior interosseous nerve) in 13 cases (5.70%), and at area IV (distal forearm to wrist) in 124 cases (54.39%). The delayed operations included delayed suture (50 cases, 21.93%), nerve release (149 cases, 65.35%), and nerve graft (29 cases, 12.72%). ResultsFor patients with injury at area I and area II, the results were good in 23 cases (25.27%), fair in 56 cases (61.54%), and poor in 12 cases (13.18%) according to modified Birch and Raji’s median nerve grading system;there was significant difference in the results between 3 repair methods for injury at area II (χ2=6.228, P=0.044), but no significant difference was found for injury at area I (χ2=2.241, P=0.326). Twelve patients (13.18%) needed musculus flexor functional reconstruction. Recovery of thenar muscle was poor in all patients, but only 5 cases (5.49%) received reconstruction. Thirteen cases of nerve injury at area III had good results, regardless of the repair methods. For patients with injury at area IV, the results were excellent in 6 cases (4.84%), good in 22 cases (17.74%), fair in 72 cases (58.06%), and poor in 24 cases (19.35%) according to Birch and Raji’s grading system;there was significant difference in the results between 3 repair methods (χ2=12.646, P=0.002), and the result of delayed repair was better. ConclusionThe results of delayed repair is poor for all median nerve injuries, especially for high level injury. The technique of repair methods vary with injury level. For some delayed median nerve injuries, early nerve transfer may be a better choice for indicative patients.
Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
Objective To study an effect of the peripheral nerve allograft with subcutaneous preservation at different times on the sciatic nerve regenerationin rats. Methods Fifty-five Wistar rats were used in this experiment, which were randomly divided into the following 5 groups: the experimental groups (Groups A, B, C, 10 rats), the control group (Group D, 10 rats), and the donorgroup (Group E, 15 rats). In the experimental groups, a 15-mm segment of the sciatic nerve harvested from the donors was separately inserted into the subcutaneous compartment on the left thigh after the 1week (Group A), 2-week (Group B), and 3week (Group C) preservation; the segment of the sciatic nerve in the subcutaneous compartment was removed and transplanted into a 10-mm defect of theright sciatic nerve, which was made immediately. In Group D, a 10-mm sciatic nerve defect was made and immediately repaired in situ on the right thigh. The function of the sciatic nerve was evaluated by the sciatic functional index (SFI) at 2, 4, 6, 8, 10 and 12 weeks after operation. The histological and electrophysiological examinations were performed at 12 weeks after operation. Results After operation, SFI decreased gradually at 12 weeks afteroperation, SFI inGroups A and D was at the minimal level and had a significant difference compared with that in Groups B and C (Plt;0.05).There was no significant difference between Group A and Group D. A large number of the myelinated nerve fibers and a small number of the unmyelinated nerve fibers were regenerated in Groups A and D. The number and the structure of the regenerated nerve were similar to the normal ones. The number and the size of the regenerated axon had a significant difference compared with those in Groups B and C (Plt;0.05). There was no significant difference between Group A and Group D. The conduction velocity and the latent period of the motor nerve had significant differences between Groups A and D and Groups B and C (Plt;0.05), and there was no significant difference betweenGroupA and Group D. Conclusion The nerve allograft with a 1-weeksubcutaneous preservation can promote nerve regeneration better.
A 0.6cm segment of right common peroneal nerve was resected in 60 SpragueDawley rats. The nerve defects were bridged by adhering the epineurium with autogenous nerve, vein, skeletal muscle, tendon and silastic tube. According to the kinds of the grafts used, the rats were divided into 5 groups. In 6 and 12 weeks after operation, the effect was assessed by motor nerve conduction velocity, weight of the anterior tibial muscle, number of distal axons and histological examination. It was demonstrated that the result from autogenous nerve graft was superior to other grafts in all aspects and that of the vein graft was better thanthe other three. The characteristics of the nerve regeneration and the process of maturation in different types of the grafts were discussed. The related microenvironment which caused the difference was also discussed.
Objective To investigate the appropriate concentration of tripterygium wilfordii and immunological rejection of rats’ sciatic nerve allograft with the tripterygium wilfordii’s pretreatment so as to explore tripterygium wilfordii’ s suppression. Methods Sixty SD rats (male, weighing 270-290 g), as sciatic nerve allograft acceptor were randomized into5 groups (groups A, B, C, D and E, n=12). To repair the sciatic nerve defect of SD rats, the Wistar rats’ sciatic nerve allografts about 15 mm long were used with 24 hours’ soak of different concentrations of tripterygium wilfordii (group A: 200 mg/L, group B: 400 mg/L, group C: 800 mg/L). The control groups (group D: the fresh sciatic nerve allograft from donors; group E: the fresh sciatic nerve allograft from themselves) were establ ished. At different time points after operation, the morphological examinations (the observation of histology, l ight microscope, electron microscope), the detection of myelin basic protein’s (MBP) content and the analyses of CD4+ and CD8+ T cells on the allografts in the acute phase were performed Results There was no significant difference in morphology among groups A, B and C, the adhesions between allografts and connective tissue were milder than that of group D, and the allografts’ morphous and the inflammatory cell infiltration were better than that of group D. The degeneration of myel in sheath was observed at different levels and there was no significant difference between group B and group E (P gt; 0.05). There was a significant difference in immunological rejection between groups A, B, C and group D (P lt; 0.05). Conclusion Tripterygium wilfordii can effectively suppress the acute immunological rejection in the early stage after operation, and protect the myel in sheath to a certain extent.