Chitosan tube bridging autologous nerve segments for the repair of long-segmental sciatic nerve defects

BACKGROUND：Previous tissue-engineered nerve studies have focused on artificial nerve and nerve cell cultures.The effects of regeneration chambers with autologous nerve bridging for the repair of nerve defects remain unclear.OBJECTIVE：To explore the feasibility and advantages of chitosan tube bridging autologous nerve segments for repairing 12-mm sciatic nerve defects in rats.DESIGN,TIME AND SETTING：A randomized,controlled,animal study using nerve tissue engineering was performed at the Animal Laboratory and Laboratory of Histology and Embryology,Liaoning Medical University from June 2008 to March 2009.MATERIALS：Chitosan powder was purchased from Jinan Haidebei Marine Bioengineering,China.METHODS：A sciatic nerve segment of approximately 8 mm was excised from the posterior margin of the piriformis muscle of Sprague Dawley rats.The two nerve ends shrank to form a 12-mm defect,and the nerve defect was repaired using a chitosan tube bridging autologous nerve segment （bridge group）,a chitosan tube-encapsulated autologous nerve segment （encapsulation group）,and a chitosan tube alone （chitosan tube alone group）,respectively.MAIN OUTCOME MEASURES：Histological and ultrastructural changes of the injured sciatic nerve;number of regenerated myelinated nerve fibers; nerve conduction velocity; leg muscle atrophy; and sciatic nerve functional index.RESULTS：At 4 months after implantation,the chitosan tube was absorbed.The tube was thin,but maintained the original shape,and vascular proliferation was observed around the tube.In the bridge group,regenerative myelinated nerve fibers were thick and orderly,with a thick myelin sheath and intact axonal structure.The number of myelinated nerve fibers and nerve conduction velocity were significantly greater compared with the other groups （P〈 0.01）.Moreover,nerve and muscle function was significantly improved following chitosan tube bridging autologous nerve segment treatment compared with the other groups （P〈 0.05 or P 〈 0.01）.CONCLUSION：Chitosan tube bridging autologous nerve segments exhibited better repair effects on nerve defects compared with chitosan tubeencapsulated autologous nerve segments and a chitosan tube alone.This method provided a simple and effective treatment for long-segmental nerve defects.

Autologous nerve segment-bridging regeneration chambers for the repair of sciatic nerve defects

Proximal and distal nerve defects exhibit chemotactic growth over certain distances. Our previous studies demonstrated that Schwann cells survive in autologous nerve segments that are bridged by regeneration chambers and secrete various bioactive substances. However, more data are required to determine the required length of regeneration chambers for chemotaxis and nutrition of neural regeneration, as well as the length of repaired nerve defects to replace the effect of autologous nerve grafting. In the present study, sciatic nerve defects of 12, 16, 20 mm were repaired using a regeneration chamber of 6, 8, and 10 mm in length respectively. These were bridged with autologous nerve segments. Results showed that the bridging of two 6-mm long regeneration chambers to repair a 12-mm nerve defect exhibited similar effects to autologous nerve grafting.

Morphological features of allogenic nerve segment in rats after subcutaneous embedment

BACKGROUND ： Some studies demonstrate that allogenic peripheral nerve segment embedded subcutaneously significantly reduce the infiltration of lymphocyte and decrease immunological reaction.OBJECTIVE ： To observe the gross shape, optical and electron microscope results of allogenic nerve segment in rats 2 weeks after subcutaneous embedment, and compare with subcutaneous emdedment of autologous nerve segment. DESIGN ： A randomized and controlled experiment.SETTING ： Department of Orthopaedics of Fifth People＇s Hospital of Zhengzhou; Department of Orthopaedics,First Hospital Affiliated to Chongqing Medical University.MATERIALS ： Totally 30 adult healthy Wistar male rats, with body mass of （200±20） g, were enrolled. Ten rats were chosen as the donors of allogenic nerve transplantation. The other 20 rats were randomly divided into 2 groups： allogenic nerve embedment group and autologous nerve embedment group, with 10 rats in each one. JEM-1220 transmission electron microscope （Japan） and Olympus BX50 optical microscope （Japan） were used. METHODS ： This experiment was carried out at the laboratory of Orthopaedic Department, Chongqing Medical University from October 2000 to April 2002. ① Sciatic nerve of donor rats for allogenic nerve transplantation was cut off at 5 mm distant from pelvic strait.15 mm sciatic nerve segment was chosen from lateral part as graft, allogenic nerve embedment group： 15 mm sciatic nerve form the donor rats was embedded in the posterior part of right legs. Autologous nerve embedment group： 15 mm sciatic nerve segment of autologous left side was embedded in the posterior side of right legs. ② Nerve segment embedded subcutaneously was taken out at postoperative 2 weeks and performed gross observation; then 5 samples chosen randomly respectively from 2 groups and given haematoxylin-eosin staining and observation under optical microscope （×400）;The other 5 samples were made into ultrathin sections （0.5μm）and observed under transmission electron microscope（×17 000）. MAIN OUTCOME MEASURES ： Gross shape, optical and electron microscope results of nerve segments of rats between two groups at 2 weeks after subcutaneous embedment. RESULTS ： ① Results of gross observation： Appearance of nerve segment was similar between 2 groups. ② Results of optical observation： medullary sheath denaturation, axonotmesis, vascular engorgement, desmoplasia of adventitia and infiltration of inflammatory cells were all found in both 2 groups. Inflammatory reaction was a little more severe in the allogenic nerve embedment group than in the autologous nerve embedment groups.③Results of electron microscope ： Similar cataplasia and denaturation of medullary sheath and cataplasia of Schwann cell were all found in the 2 groups. CONCLUSION： Some inflammatory reaction occurs after allogenic nerve embedment, but the activity of Schwann cell is similar to that of peripheral nerve after autologous nerve embedment.

Using nerve segment insert grafting to reconstruct neural pathways of brain-derived paralysis

Since 1992,task groups have used free nerve auto grafts to bridge partially transected nerves from the dominant area of the normal cerebral cortex to nerves that innervate spastic muscles from a diseased cerebral cortex,using transplanting sutures to alleviate the muscle spasm of cerebral palsy caused by different diseases. This has facilitated rebuilding of some of its neurological function. In this study,80 such patients were followed up,including 20 patients with traumatic brain injury,32 patients with stroke,and 28 pediatric patients with cerebral palsy. After postoperative follow-up of 3 to 21 years,the efficacy rate of this operation was 100% and the excellent and good spasm relief rate was 82.5%.