嗅鞘细胞移植治疗陈旧性颈髓损伤的临床观察

Efficiency of olfactory ensheathing cell transplantation in the treatment of obsolete cervical spinal cord injury

目的 观察嗅鞘细胞移植对陈旧性颈髓损伤患者远期功能改善的效果.方法 回顾性分析2008 年1 月至2011 年12 月洛阳正骨医院采用嗅鞘细胞移植治疗陈旧性颈髓损伤患者8 例.其中男5 例,女3 例;年龄32 - 65 岁（中位年龄53 岁）;病程8 - 48个月,平均15 个月.按照美国脊髓损伤学会制定的ASIA 评分标准及功能独立性评定（FIM）量表评分对患者移植前后进行评估,并对患者安全性进行统计学观察,手术前后不同时间神经功能评分结果比较采用随机区组的F 检验.结果 8 例患者有6 例获得随访,随访时间6 - 38 个月,平均24 个月.8 例患者评估及随访结果显示其中7 例MRI 显示脊髓未完全中断患者均有明显改善,1 例MRI 检测显示脊髓完全中断患者改善不明显.ASIA 术前为（145.62 ± 51.48）分,术后3 个月至2 年从（176.75 ± 43.59）分升高至（187.37 ± 41.24）分（F = 52.140,P = 0.000）;FIM 术前为（78.00 ± 21.78）分,术后3 个月至2 年从（86.63 ± 22.12）分上升至（96.12 ± 19.31）分（F = 55.127,P = 0.000）.FIM 显示2 例由重度依赖转为中度依赖,2 例由中度依赖转为轻度依赖,3 例FIM 评分增加依赖程度无改变,1 例改善不明显.结论 嗅鞘细胞移植能够改善脊髓连接不完全中断损伤患者功能,对脊髓连接完全中断患者改善不明显.嗅鞘细胞移植对脊髓损伤患者的部分脊髓神经功能恢复有帮助.

Objective To observe the long-time functional improvement and the safety of olfactory ensheathing cell （OEC） transplantation for patients with obsolete cervical spinal cord injury. Methods Eight patients （5 males and 3 females） were treated with OEC transplantation from January 2008 to December 2011. The mean age was 53 years （range： 32-65 years）. The mean duration of disease was 15 months （range： 8 to 48 months）. Efficiency was assessed according to the ASIA scoring criteria developed by the American Spinal Injury Association and Functional Independence assessment （FIM） scale before and after transplantation. Results Six patients were followed up, the mean followed-up time was 24 months （range： 6 to 38 months）. Seven whose spinal cords were not completely interrupted as shown by MRI patients improved significantly. The only patient whose spinal cord was completely interrupted did not improve. ASIA and Functional Independence Measurement （FIM） scale scores improved significantly after treatment （F = 55.127, P 〈 0.05）. Conclusions OEC transplantation can improve the function in patients whose spinal cords are not completely interrupted and transplantation is safe.