自体外周血单个核细胞治疗高位桡神经离断伤

Efficacy of autologous peripheral blood mononuclear cells in treatment of high radial nerve injury

背景:近年来神经干细胞、脂肪间充质干细胞、肌源性干细胞、诱导多能干细胞已应用于治疗周围神经损伤,但自体外周血单个核细胞应用于外周神经损伤的治疗鲜有报道。目的:观察自体外周血单个核细胞治疗高位桡神经离断伤的疗效。方法:自2011年4月至2015年9月,共收治上臂中段桡神经离断伤12例,术前动员外周血单个核细胞,手术当日提取外周血单个核细胞悬液15 mL,手术探查吻合桡神经,显微镜下行端端外膜缝合法吻合神经,用浸泡5 mL自体外周血单个核细胞悬液的凝胶海绵包裹神经吻合口,剩余10 mL外周血单个核细胞悬液行局部肌肉多点注射,每点注射0.5 mL,缝合深筋膜,常规缝合伤口。术后给予抗生素预防感染48 h,上肢制动4周,指导患者康复锻炼。随访观察腕关节背伸度数、伸腕伸指肌肌力,进行疗效评价。结果与结论:(1)术后患者均获随访,随访时间15-36个月,平均17个月;(2)综合评价:优9例,良2例,可1例,差0例,优良率为92%;(3)腕关节背伸均能够达到功能需要,拇指背伸、伸指基本满足功能要求;(4)结果提示,自体外周血单个核细胞移植治疗高位桡神经损伤效果满意。

BACKGROUND:In recent years,neural stem cells,adipose tissue derived mesenchymal stem cells,muscle derived stem cells and induced pluripotent stem cells have been applied in the treatment of peripheral nerve injuries.However,the treatment of peripheral nerve injury by autologous peripheral blood mononuclear cell transplantation has been rarely reported.OBJECTIVE:To investigate the efficacy of autologous peripheral blood mononuclear cells in the treatment of high radial nerve injury.METHODS:From April 2011 to September 2015,12 cases of radial nerve injury in the middle arm were treated.Preoperatively peripheral blood mononuclear cells were mobilized,and then 15 mL of mononuclear cell suspension was prepared on the operation day.Radial nerves scheduled for anastomosis were surgically explored and subjected to end-end anastomosis using outer membrane suturing under microscope.The anastomotic site of the nerve was enveloped with gelatin sponge soaked with 5 mL of autologous peripheral blood mononuclear cell suspension.The remaining 10mL of cell suspension was used for a multi-point injection into the local muscles,0.5 mL at each point.Thereafter,the deep fascia and the incision were sutured in sequence.Postoperative antibiotic treatment was used to prevent infection for 48 hours,and upper limb immobilization lasted for 4 weeks.Performance of rehabilitation exercise was guided.During the follow-up,wrist dorsal extension and muscle strength of extensor carpi ulnaris and extensor digitorum communis were detected to evaluate the therapeutic efficacy.RESULTS AND CONCLUSION:All the patients were followed up for 15 to 36 months,with an average of 17 months.Efficacy was excellent in 9 cases,good in 2 cases,fair in 1 case and poor in 0 case.The excellent and good rate was 92%.The wrist dorsal extension could achieve the functional needs,and the thumb dorsal extension and finger extension basically met the functional requirements.It is suggested that autologous peripheral blood mononuclear cell transplantation can achieve good outcomes in the treatment of high radial nerve injury.