神经生长因子缓释系统在周围神经松解术中的应用

Clinical application of nerve growth factor delivery release system on treatment of peripheral nerve relaxation

目的：探讨神经生长因子（NGF）缓释系统在周围神经松解术中的应用疗效。方法对解放军第九八医院全军创伤骨科中心2011年3月—2013年5月收治的36例前臂及腕部正中神经完全断裂患者进行前瞻性研究,在修复术后3个月常规进行神经松解手术,采用单盲随机化法分为A 组（18例）、B 组（18例）。 A 组患者利用自制的缓释系统进行 NGF（共30 mL,质量浓度8.12 mg/mL）局部缓释,B 组患者用等量的 NGF 在神经周围明胶海绵包绕后局部注射。8周后进行神经电生理检查,比较两组患者体感诱发电位（SEP）、复合肌肉动作电位（CMAP）的变化,并对运动神经传导速度（NCV）作进一步分析；24周后分别行英国医学研究委员会（BMRC）感觉及运动功能评定标准评分。结果术后8周 A、B 两组 SEP 中潜伏期分别为（20.56±3.50） ms、（32.25±4.61）ms,波幅分别为（17.22±3.46）μV、（9.90±1.37）μV；A、B 两组 CMAP 中潜伏期分别为（2.10±0.37）ms、（4.31±0.66）ms,波幅分别为（810.9±108.16）μV、（506.61±67.50）μV,两组的 NCV 分别为（41.21±3.34）m/ s、（30.68±2.21）m/ s；与 B 组相比,A 组 SEP、CMAP 潜伏期明显缩短,波幅明显增高,NCV明显增快,差异均有统计学意义（P 值均〈0.01）,BMRC 感觉功能评分中,A、B 两组的优良率分别为16/18、12/18；运动功能评定中,A、B 两组的优良率分别为14/18、9/18； A 组 BMRC 运动功能优于B 组,差异均有统计学意义（P 值均〈0.05）。结论 NGF 缓释系统可明显促进神经松解术后神经功能的恢复,可作为神经损伤后期治疗的补充手段,操作简单,值得临床推广。

Objective To prepare nerve growth factor delivery release system , and explore its clinical effects on peripheral nerve relaxation. Methods Thirty six patients of patients with median nerve injuries in the forearm and wrist were strictly followed up and accepted neurolysis after 3 months in the 98th Hospital of PLA from March 2011 to May 2013. The patients were randomly divided into group A （18 patients） and B group （18 patients）. The NGF（total 30 mL, concentration of 8. 12 mg/ mL） was used to partial release by using the homemade delivery release system in group A, the same amount of NGF was partial injected to Gelatin sponge surrounding peripheral nerve in group B. All patients respectively underwent neural electrophysiological examination after 8 weeks. The somatosensory evoked potentials （SEP） and compound muscle action potentials （CMAP） between different groups were compared, and motor nerve conduction velocity （NCV） was also analyzed. The sensory and motor function evaluation score of British Medical Research Council（BMRC） were performed after 24 weeks. Results The peak latency of the SEP after 8 weeks in A and B groups were （20. 56 ± 3. 50）ms and（32. 25 ± 4. 61）ms, respectively. The volatility were （17. 22 ± 3. 46） μV and （9. 90 ± 1. 37） μV, respectively. The peak latency of the CMAP after 8 weeks in A and B groups were （2. 10 ± 0. 37）ms and（4. 31 ± 0. 66）ms, respectively. The volatility were （810. 9 ± 108. 16）μV and（506. 61 ± 67. 50）μV, the NCV were （41. 21 ± 3. 34）m/ s and（30. 68 ± 2. 21） m/ s, respectively. Compared with the group B, the peak latencies of the SEP and CMAP were shortened significantly and the Volatility was increased significantly in group A, the NCV was faster in group A（all P values 〈 0. 01）. The good rate of the A and B groups in BMRC sensory function score were 16 / 18 and 12 / 18, respectively. The good rate in BMRC motor function score were 14 / 18 and 9 / 18, respectively.＆amp;nbsp;The good rate in group A was higher than that in group B（ all P values 〈 0. 05） . Conclusions Nerve growth factor delivery delivery system is effective in promoting the recovery of neurological function after neurolysis , and can be used as a supplementary means of nerve damage in the later stage. It is simple to operate and worthy of promoting.