恒河猴旋前圓肌肌支神經(jīng)套接修復(fù)尺神經(jīng)：存在神經(jīng)軸突再生的倍數(shù)擴(kuò)增

1、.SICENCE新聞發(fā)布 作者：寇玉輝 稿號(hào)：NRR_281_14恒河猴旋前圓肌肌支神經(jīng)套接修復(fù)尺神經(jīng)：存在神經(jīng)軸突再生的倍數(shù)擴(kuò)增周圍神經(jīng)轉(zhuǎn)位修復(fù)是臨床常規(guī)神經(jīng)修復(fù)技術(shù)無(wú)法實(shí)施的情況下采用的一種修復(fù)方法， 主要用于周圍神經(jīng)根性撕脫性損傷和長(zhǎng)段神經(jīng)缺損。在神經(jīng)轉(zhuǎn)位修復(fù)中，由于選用的供體神經(jīng)多為細(xì)小的、非重要神經(jīng)，而被修復(fù)的神經(jīng)，則通常為粗大的、重要神經(jīng)，既往的神經(jīng)轉(zhuǎn)位修復(fù)往往會(huì)存在供體神經(jīng)纖維數(shù)量過(guò)少，引起修復(fù)神經(jīng)的支配神經(jīng)的動(dòng)力不足，影響神經(jīng)功能。周圍神經(jīng)修復(fù)再生過(guò)程中存在多芽再生的特性，近年來(lái)隨著對(duì)周圍神經(jīng)這一特殊再生特性的重新認(rèn)識(shí)，神經(jīng)轉(zhuǎn)位修復(fù)的臨床意義和應(yīng)用前景有了全新的認(rèn)識(shí)和評(píng)估。來(lái)自

2、中國(guó)北京大學(xué)人民醫(yī)院和北京大學(xué)交通醫(yī)學(xué)中心姜保國(guó)教授領(lǐng)導(dǎo)的團(tuán)隊(duì)前期系統(tǒng)地對(duì)周圍神經(jīng)多芽再生進(jìn)行了研究，證實(shí)在一定供體/受體神經(jīng)纖維比例情況下，可以使受體神經(jīng)纖維得到絕大部分神經(jīng)再支配。該團(tuán)隊(duì)在前期研究基礎(chǔ)上，設(shè)計(jì)了以恒河猴為實(shí)驗(yàn)動(dòng)物，建立旋前圓肌肌支修復(fù)尺神經(jīng)缺損模型，小間隙套接縫合法將旋前圓肌肌支近端與尺神經(jīng)遠(yuǎn)端套接縫合，6個(gè)月后恒河猴患肢尺側(cè)可恢復(fù)2指屈曲運(yùn)動(dòng)和輕度的屈腕運(yùn)動(dòng)；神經(jīng)電生理測(cè)量到恒河猴修復(fù)側(cè)神經(jīng)運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度可達(dá)（22.63±6.34）m/s，鋨酸染色發(fā)現(xiàn)供體旋前圓肌肌支神經(jīng)有髓神經(jīng)纖維為（1,657±652）根，修復(fù)尺神經(jīng)有髓神經(jīng)纖維為（2,661&#

3、177;843）根，再生有髓神經(jīng)再生倍數(shù)擴(kuò)增率為1.61。進(jìn)一步證實(shí)旋前圓肌肌支神經(jīng)再生的神經(jīng)纖維可以有效再生，并在一定程度恢復(fù)受損尺神經(jīng)功能，且在這種修復(fù)模式下，修復(fù)后的尺神經(jīng)軸突存在再生倍數(shù)擴(kuò)增現(xiàn)象。相關(guān)文獻(xiàn)發(fā)表于中國(guó)神經(jīng)再生研究（英文版）雜志2015年1月第1期。鋨酸染色顯示，旋前圓肌肌支修復(fù)尺神經(jīng)損傷恒河猴模型，經(jīng)小間隙套接縫合法縫合6個(gè)月后，近端旋前圓肌肌支內(nèi)有髓神經(jīng)纖維形態(tài)結(jié)構(gòu)接近正常尺神經(jīng)組織結(jié)構(gòu)，神經(jīng)纖維均勻密集排列Article: " Sleeve bridging of the rhesus monkey ulnar nerve with muscular bra

4、nches of the pronator teres: multiple amplifcation of axonal regeneration," by Yu-hui Kou, Pei-xun Zhang, Yan-hua Wang, Bo Chen, Na Han, Feng Xue, Hong-bo Zhang, Xiao-feng Yin, Bao-guo Jiang (Department of Trauma and Orthopedics, Peking University Peoples Hospital, Beijing, China)Kou YH, Zhang

5、PX, Wang YH, Chen B, Han N, Xue F, Zhang HB, Yin XF, Jiang BG (2015) Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration. Neural Regen Res 10(1):53-59.欲獲更多資訊：Neural Regen Res Multiple amplification of axonal reg

6、eneration in regenerating nerve fibers Peripheral nerve transfer is a common method for treating peripheral nerve injury of proximal donor deficiency and has been extensively used to treat brachial plexus injury and long-segment nerve defects. For the nerve transfer, the majority of the selected don

7、or nerves are tiny and not important ones, while the nerves to be repaired are often thick and important ones. In the previous nerve transfer, donor nerve fibers are not insufficient in amount, leading to poor neurological function. Multiple-bud regeneration, i.e., multiple amplification of nerve re

8、generation, has been shown in peripheral nerve regeneration. In recent years, with a thorough understanding of peripheral nerve regeneration, the clinical significance and application prospect of nerve transfer has been re-recognized. Bao-guo Jiang, Peking University Peoples Hospital, China and his

9、colleagues confirmed that under optimal proportion of receptor to donor nerve fibers, the majority of receptor nerve fibers are re-innervated. Based on previous studies, they established rhesus monkey models of distal ulnar nerve defects and repaired using muscular branches of the right forearm pron

10、ator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological ex

11、amination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the re

12、paired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of

13、 the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons. These results were published in Neural Regeneration Research (Vol. 10, No. 1, 2015).At 6 months after model establishment, osmium tetroxide staining results re

14、veal that myelinated nerve fibers in the proximal muscular branches of the pronator teres were uniform and densely arranged, and their morphology and structure were similar to that of normal nerve tissue. Article: " Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplifcation of axonal regeneration," by Yu-hui Kou, Pei-xun Zhang, Yan-hua Wang, Bo Chen, Na Han, Feng Xue, Hong-bo Zhang, Xiao-feng Yin, Bao-guo Jiang (Department of Trauma and Orthopedics, Peking University Peoples Hospital, Beijing, China)Kou YH, Zhang PX, Wa