人胚胎雪旺细胞脊髓内移植治疗晚期脊髓损伤

Schwann cell transplantation for the treatment of chronic spinal cord injury

目的采用人胚雪旺细胞移植治疗晚期脊髓损伤,并探讨其疗效及安全性。方法显微镜下切除脊髓损伤节段增厚的瘢痕组织,松解粘连,切开囊腔或空洞。取人胚胎背根神经节,培养成雪旺细胞并贴附于可吸收薇乔3-0紫色线及薇乔网的载体上,然后将其移植到脊髓损伤部位。本组共治疗53例,其中男42例,女11例,年龄2～58岁,伤后时间为4个月～19年。结果雪旺细胞移植后2～8w时随访,按美国脊髓损伤学会(ASIA)脊髓损伤神经功能分类国际标准评价,53例患者的脊髓功能均有部分恢复,其中运动功能由术前(41.49±15.83)分提高到术后(44.62±15.39)分,轻触觉由(57.89±22.87)分提高到(63.94±23.67)分,针刺觉由(55.96±20.99)分提高到(59.68±20.57)分。患者术后无脊髓感染、功能损伤加重及死亡等并发症。术后复查MRI示脊髓无瘤样增生及空洞扩大。结论人胚雪旺细胞移植治疗晚期脊髓损伤安全可行,能促进晚期脊髓损伤患者脊髓神经功能的部分恢复。

Objective The present clinical study was undertaken to assess the safety, feasibility and curative efficacy of transplantation of fetal human Schwann cell into injured spinal cord of paraplegic patients and to observe their spinal cord function recovery. Methods The scars and necrotic tissues in the injured spinal cord were dissected and removed, and the cavities and cysts in the injured segnents were opened and cleared. Schwann cell was prepared from the fetal human dorsal root nerves and adhered to 3 -0 absorbable purple suture and mesh. Then, they were transplanted into injured spinal cord segnents in 42 male and 11 female paraplegic patients （aged from 2 to 58 years）, who had suffered for 4 to 228 months since spinal cord injury. Results Spinal cord pulse recovery occurred after Schwann coil transplantation surgery. According to the international standards of American Spinal Injury Association （ASIA）, 53 eases iraproved partially neurolngical function after 2 to 8 w compared with pre-surgery. The motor, light touch and pin prick increased from 41.49 ± 15. 83, 56. 28 ± 21.04 and 55. 96 ± 20. 99 to 44. 62 ± 15. 39, 63.94±23.67 and 59.68±20.57, respectively. Furthermore, no death, fever, spinal cord infetion and function deterioration occurred after transplantation of Schwann coil into the spinal cord. MRI findings also indicated that no neoplastic hyperplasia, enlarged cavities or cysts presented. Conclusion The therapeutic scheme of transplantation of Schwann coil into chronic injured spinal cord is safe, feasible and helpful to the recovery of spinal cord function in patients.