新鲜羊膜修复急性坐骨神经损伤

发布时间：2018-04-24 13:01

本文选题：羊膜 + 生物膜　；参考：《中国组织工程研究》2017年18期

【摘要】：背景:改善局部微环境及减少局部瘢痕有利于周围神经再生促进神经功能恢复。目的:评价新鲜羊膜促进周围神经损伤后再生的效果。方法:选用成年SD大鼠60只,制备单侧坐骨神经急性损伤模型,随机分为人羊膜组、生物膜组、空白对照组,每组20只,均在显微镜下行神经吻接术,吻接处给予人新鲜羊膜、生物膜包裹,空白对照组修复神经后不做任何处理。术后2,4,8,12周行大体观察、光镜观察、免疫组织化学检测;术后4,8,12周行透射电镜观察、轴突成像分析、复合肌肉动作电位检测、坐骨神经功能指数测定。结果与结论:(1)大体观察:术后2周羊膜、生物膜局部稍有吸收,4周大部吸收,8周完全吸收。人羊膜组、生物膜组神经和周围组织稍有粘连且粘连较疏松,活动度可。空白对照组神经和周围组织广泛紧密粘连,钝性不易分离,活动度差;(2)光镜观察:术后2,4,8,12周,人羊膜组、生物膜组神经恢复情况明显优于空白对照组;(3)电镜观察:术后4周,3组神经纤维再生均不明显,板层结构均不清晰。术后8,12周,与空白对照组比较,人羊膜组、生物膜组神经纤维再生数量更多、髓鞘厚度厚、板层结构更清晰、轴突直径更大;(4)免疫组织化学检测:人羊膜组、生物膜组中S-100蛋白表达及分布均优于同时期空白对照组;(5)轴突图像分析:人羊膜组、生物膜组神经吻合口远端有髓神经纤维直径、髓鞘厚度及横截面有髓神经纤维数目均优于同时期空白对照组,差异有显著性意义(P0.05);(6)神经电生理检测:与空白对照组比较,人羊膜组、生物膜组潜伏期短、波幅高及神经传导速度快,差异有显著性意义(P0.05);(7)坐骨神经功能指数:人羊膜组、生物膜组坐骨神经功能指数均明显高于同时期空白对照组,差异有显著性意义(P0.05);(8)结果表明,人羊膜作为一种生物材料修复周围神经损伤效果较好,可以减轻受损神经与周围组织的粘连和减少神经吻合处的瘢痕形成,可促进神经纤维再生、轴突直径增大、髓鞘增厚,可以减轻神经切口处炎性反应、免疫反应。
[Abstract]:Background: improving local microenvironment and reducing local scar are beneficial to peripheral nerve regeneration and nerve function recovery. Objective: to evaluate the effect of fresh amniotic membrane on regeneration after peripheral nerve injury. Methods: sixty adult SD rats were randomly divided into human amniotic membrane group, biofilm group and blank control group. Biofilm encapsulated, blank control group after nerve repair did not do any treatment. At 12 weeks after operation, gross observation, light microscope observation and immunohistochemical examination were performed, and transmission electron microscopy, axonal imaging, combined muscle action potential and sciatic nerve function index were observed 12 weeks after operation. Results and conclusion: at 2 weeks after operation, the biofilm was slightly absorbed and most of the biofilm absorbed completely at 8 weeks. In human amniotic membrane group and biofilm group, there was a slight adhesion between nerve and surrounding tissue, and the adhesion was looser. In the blank control group, the nerve and surrounding tissues were closely conglutinated widely, the blunt nature was not easy to be separated, and the activity was not easy to be separated. The observation under light microscope was as follows: 12 weeks after the operation, the human amniotic membrane group was treated with human amniotic membrane. The nerve recovery in the biofilm group was significantly better than that in the blank control group. The nerve fiber regeneration was not obvious and the lamellar structure was not clear 4 weeks after operation in the biofilm group. 812 weeks after operation, compared with the blank control group, the number of nerve fibers regenerated in the human amniotic membrane group and the biofilm group were more abundant, the thickness of myelin sheath was thicker, the lamellar structure was clearer, and the axon diameter was larger. The expression and distribution of S-100 protein in the biofilm group were superior to those in the control group (P < 0.05). The diameter of myelinated nerve fibers at the distal end of nerve anastomosis in human amniotic membrane group and biofilm group was higher than that in the control group. The thickness of myelin sheath and the number of myelinated nerve fibers in cross section were better than those in the control group at the same time, and the difference was significant (P 0.05). Compared with the blank control group, the incubation period of human amniotic membrane group and biofilm group was shorter than that of the blank control group. The sciatic nerve function index of human amniotic membrane group and biofilm group were significantly higher than that of the control group in the same period, and the difference was significant (P 0.05). As a biomaterial, human amniotic membrane can reduce the adhesion between the injured nerve and the surrounding tissues, reduce the scar formation in the nerve anastomosis, promote the regeneration of nerve fibers, increase the diameter of axons and increase the thickness of myelin sheath. It can reduce inflammatory reaction and immune reaction in the nerve incision.
【作者单位】：河北医科大学第三医院;
【基金】：河北省自然科学基金(ZL20140066)~~
【分类号】：R318.08;R688

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