ObjectiveTo evaluate the long-term effects on the lower limb function after S1 nerve root transection as dynamic source. MethodsBetween January 2007 and December 2011, 47 patients with atonic bladder dysfunction underwent S1 nerve root transposition to reconstrut the bladder function. There were 43 males and 4 females, with an average age of 40.7 years (range, 22-66 years). The locations were LS1 in 33 cases, LS2 in 5 cases, LS3 in 2 cases, TS12, LS1 in 3 cases, LS1, LS2 in 1 case, LS1, LS3 in 1 case, LS1, LS4 in 1 case, and LS2, LS3 in 1 case. The anastomosis of the SS2 or SS3 nerve root to S1 nerve root was performed from 4 to 24 months (mean, 8 months) after spinal cord injury. The strength of ankle plantar flexion was grade 4 in 5 cases and grade 5 in 42 cases before operation. ResultsThe strength of ankle plantar flexion had no obvious decrease (grade 4 or 5) in 31 cases, reduced 0.5 grade in 16 cases at 2 days after operation. All the patients were followed up 3-8 years (mean, 5.1 years). At 2 weeks after operation, the nerve electrophysiological examination showed neurogenic damage at operated side in most patients, including reduced amplitude tibial nerve in 19 cases, for common peroneal nerve in 13 cases, and for tibial nerve and common peroneal nerve in 9 cases. Except the velocity of common peroneal nerve (t=-1.881, P=0.093), the other electric physiological indexes showed significant differences between at pre- and post-operation (P<0.05). The muscle strength basically recovered to preoperative level (grade 4 or 5) during follow-up, and there was no impairment of lower limb function. ConclusionS1 transection has no significant effects on lower limb function, so S1 nerve can be used as dynamic nerve for nerve function reconstruction.
ObjectiveTo study the long-term prevention effect of self-developed chitosan electrospun membrane on cerebrospinal fluid leakage. MethodsTwenty-five healthy adult New Zealand rabbits were selected to prepare the bilateral dural defect (0.8 cm×0.8 cm in size) via midline incision of head.Defect of the right was repaired with chitosan electrospun membrane as the experimental group; defect of the left was not repaired as the control group.At 2-16 weeks after operation,one rabbit was sacrificed for the general observation of inflammatory response surrounding bone window and absorption of chitosan electrospun membrane; at 3 and 6 weeks after operation,5 rabbits were sacrificed for sampling to observe histological change and collagen expression by HE and Masson staining,and to measure the expressions of epidermal growth factor receptor (EGFR) and basic fibroblast growth factor (bFGF) by immunohistochemical staining. ResultsNo inflammatory reaction of swelling,exudation,and sppuration appeared in the skin and subcutaneous tissue after operation in 2 groups.There was no adhesion around the chitosan electrospun membrane,and new fiber membrane formed under the chitosan electrospun membrane in the experimental group; no cerebrospinal fluid leakage happened; the chitosan electrospun membrane was gradually degraded with time,and was completely absorbed at 16 weeks.There was uneven scar around the dural detect in control group.Histological observation showed less inflammatory cell infiltration in the experimental group,showing significant difference in the number of inflammatory cells compared with control group at 3,6 weeks (P<0.05); capillary,granulation tissue and collagen fiber massively proliferated; collagen fiber arranged in line,and there was a clear borderline between chitosan electrospun membrane and adjacent collagen fiber.The immunohistochemical staining showed that there were high expressions of bFGF and EGFR in the experimental group,and low expressions of bFGF and EGFR in the control group. ConclusionChitosan electrospun membrane for dural defect of rabbit can effectively reconstruct the dura,and it has exact long-term prevention effect on cerebrospinal fluid leakage.