组织工程化神经移植治疗臂丛神经根性撕脱伤

Tissue-engineered neural transplantation for brachial plexus root avulsion

学术背景:臂丛神经根性撕脱伤是臂丛神经损伤中最严重的类型,属节前损伤,预后极差,目前传统的神经移植术疗效并不满意,因此研究组织工程化神经移植治疗臂丛神经根性撕脱伤尤为必要。目的:探讨组织工程在神经损伤中的作用及其效果,为临床组织工程化神经移植治疗臂丛神经根性撕脱伤提供参考。检索策略:应用计算机检索PubMed数据库和中国期刊全文数据库2001-01/2007-10的有关文献,英文检索词"brachial plexus avulsion",中文检索词为"臂丛神经损伤"。共检索到410篇相关文献,其中中文文献255篇,英文文献155篇,对文献进行筛选,纳入标准:①选取针对性强,相关度高的文献。②对同一领域的文献选择近期发表或权威杂志的文献;排除重复研究和Meta分析类文章。最后34篇被选用。文献评价:选用34篇文献,其中1篇为综述、其余均为临床与实验研究。资料综合:传统的神经移位术和撕脱神经根再植术为临床上治疗臂丛神经根性撕脱伤的两种方法,效果有限。神经营养因子、唾液酸酶、软骨素酶ABC、N-乙酰半胱氨酸对受损神经元有保护和促进作用。骨髓干细胞及脊髓神经干细胞移植到脊髓受损部位后能分化成神经细胞。结论:组织工程化神经移植治疗臂丛神经根性撕脱伤可能成为更有效的临床治疗方法。

BACKGROUND： Brachial plexus root avulsion is the severest type in brachial plexus injuries. It is preganglionic lesion and its prognosis is very bad. At present, the curative effect of traditional neurotization is not satisfactory. Therefore it is necessary to explore the treatment of brachial plexus root avulsion by tissue-engineered neural transplantation. OBJECTIVE： To explore the role and effect of tissue engineering in nerve injury, so as to provide reference for the clinical treatment of brachial plexus root avulsion using tissue engineered neural transplantation. RETRIEVAL STRATEGY： The relevant articles published between January 2001 and October 2007 were retrieved from PubMed and China Journal Full-text Database using the key English words ＂brachial plexus avulsion＂ and Chinese words ＂brachial plexus injury＂. 410 literatures were retrieved, including 155 English, and 255 Chinese. Focused articles and literatures in the same field published in the near future or on the authoritative journals were included, Repetitive articles and Meta analysis articles were excluded. Finally 34 articles were selected. LITERATURE EVALUATION： Of 34 articles, one was review article, and the others were clinical and experimental studies. DATA SYNTHESIS： Curative effects of traditional nerve transposition and avulsed never reimplantation are limited. Neurotrophic factor, sialidase, chondroitinase ABC, and N-acetyl cysteine are able to protect and promote injured neuron. Bone marrow stem cells and spinal nerve stern cells can differentiate into neuron at lesion site of spinal cord after transplantation. CONCLUSION： Tissue engineered neural transplantation may be a more effective therapy for brachial plexus root avulsion.