去细胞同种异体神经移植修复人体长段周围神经缺损

Acellular nerve allograft in repair of human long-segment defect of the peripheral nerve

目的:探讨周围神经缺损的治疗方法,评价去细胞同种异体神经移植修复人体长段周围神经缺损的效果。方法:实验于2003-04-14/2004-05-14解放军总医院骨科完成。取正常健康捐献者的周围神经,进行化学处理,应用化学萃取法制备去细胞同种异体神经,对11例周围神经缺损的住院患者进行神经移植,修复神经缺损。分别于术后定期对患者进行感觉、运动功能检查,并行肌电图检查。结果:参与的11例患者,均获得随访,无缺失。7例患者术后功能有恢复,改善率64%(7/11),其中1例移植9cm修复正中神经缺损的患者术后6个月,感觉与运动功能开始恢复,术后16个月,患手能够持物,感觉和肌力恢复。11例患者中6例缺损位于腕部以上的患者恢复3例,术后6个月行肌电图检测,有神经冲动穿过,改善率50%(3/6),5例缺损位于腕部以下的患者恢复4例,改善率80%(4/8)。结论:应用化学去细胞神经同种异体移植可修复人体周围神经缺损,并且可以避免取自体神经的弊端。

AIM： To discuss the treatment of peripheral nerve defect and assess the effect of acellular nerve allograft in repairing human long-segment nerve defect. METHODS： The experiment was done in the Department of Orthopedics, General Hospital of Chinese PLA from April 2003 to May 2004. Peripheral nerve segments from healthy subscribers were onrolled and treated chemically to obtain acellular nerve with chemical extraction method. Eleven inpatients with peripheral nerve defect were subjected to receive acellular nerve allograft in order to repair nerve defect. Examination of sensation and motor function was performed after operation as well as electromyogram（EMG） examination. RESULTS： All the participants were subjected to follow-up without loss. Function recovered in 7 patients with the efficient rate of 64%（7/11）; among them, sensation and motor function began to recover at 6 months in one patient with 9 cm graft, and in 16 months after the operation, the patient could use his hand to hold objects. Among the 11 inpatients, 3 cases of the 6 cases with defects above wrists recovered, and nerve impulse was found in them with the efficient rate of 50% （3/6） at postoperatively 6 months by using EMG examination. Among other 5 patients with defects below wrists, 4 patients recovered with the efficient rate of 80%（4/8）. CONCLUSION： Acellular nerve allograft is feasible to use in the repair of human peripheral nerve defect after chemical treatment, which is a good way to avoid using nerve autograft.