周围神经损伤后神经系统的可塑性

Plasticity of the nervous system after peripheral nerve injury

目的:对周围神经损伤后神经系统发生的可塑性变化以及如何利用周围神经具有的可塑性修复周围神经损伤做一回顾性综述。资料来源:通过计算机对CNKI,万方数据,维普数据库1994/2006的中文文章,ovid数据库1960/2006的英文文章进行检索,检索词:周围神经损伤,神经可塑性;peripheralnerveinjury,nerveplasticity。资料选择:选取与周围神经损伤和神经可塑性有关的论文,无论观察对象为人或动物均纳入。资料提炼:未直接检索出同类论文,可见70余篇相关报道,选取CNKI,万方数据,维普数据库收录的发表于核心期刊上的中文文献7篇,ovid收录的英文文献13篇进行分类归纳。资料综合:通过举例说明周围神经损伤后中枢及周围神经系统发生的可塑性变化,即脊髓和大脑皮质发生的动态功能重组,外周神经纤维发生的侧支发芽、神经自身的伸缩及神经的趋化性再生。同时介绍了神经端侧、侧侧吻合,神经自身延长,神经小间隙吻合,带神经血管的肌束植入术这些利用周围神经具有的可塑性来修复周围神经损伤的方法。结论:周围神经损伤后在中枢及周围神经系统中的确存在可塑现象,如何最大化利用和挖掘这种可塑性变化将是未来周围神经修复的发展方向。

OBJECTIVE： To review the plastic changes of nervous system after peripheral nerve injury （PNI） and the ways of repairing PNI by using the plasticity of peripheral nerves. DATA SOURCES： A computer-based online search of relevant Chinese articles between 1994 and 2006 was conducted in CNKI, Wanfang database and Vip database, meanwhile, relevant English articles between 1960 and 2006 was searched in ovid database with the key words of ＂peripheral nerve injury, neural plasticity＂. STUDY SELECTION： Literatures related to the PNI and neural plasticity were selected without considering the observation subjects were people or animals. DATA EXTRACTION： Articles of the same classification had not been retrieved, and over 70 reports were found. Seven Chinese literatures were selected from articles published in the core journals of CNKI, Wanfang database and Vip database, and 13 English literatures in ovid were classified and summarized. DATA SYNTHESIS： The plastic changes of central and peripheral systems-after PNI, i.e. the dynamic functional reorganization of spinal cord and cerebral cortex, collateral sprouting of peripheral nerve fibers, stretching of nerves and chemotactic regeneration of peripheral nerve fibers. Meanwhile, repairing methods such as implantation of neurovascular muscle bundles, which could repair the PNI by utilizing the plasticity of nerve of PNI were introduced, including end-to-side and side-to-side neurorrhaphy; anastomosis with the small gap; stretching and prolongation of nerve; implantation of muscle bundle with nerve and blood vessels pedicle. CONCLUSION： There is plasticity in central and peripheral nervous systems after PNI, and how to utilize and dig into the changes of plasticity as greatest as possible is the development trend of nerve repair in the future.