To find new technique for repair of peripheral nerve defect, the nerve elongation repair technique was adopted. Two cases with nerve defect were treated by this method. One was a 12 year old male, the defect length of right radial nerve was 7.2 cm at the elbow. The other one was a 28 year old male, the defect length of left ulnar nerve the was 5 cm at elbow. In this method, the nerve was elongated by slow stretch from distal and proximal end of the ruptured nerve. After a few days, the nerve was repaired by direct suture. After operation, the function of nerves were recovered in 119 days and 114 days respectively. Follow-up for 5 years, the function of the effected limbs were recovered to the normal side. It was concluded that: (1) the peripheral never can be elongated by slow stretch; (2) to stretch the nerve end in a rubber tube can prevent adhesion and connective tissue blocking; (3) strength and supporting point of stretching should be designed carefully.
OBJECTIVE Following the delayed repair of peripheral nerve injury, the cell number of anterior horn of the spinal cord and its ultrastructural changes, motorneuron and its electrophysiological changes were investigated. METHODS In 16 rabbits the common peroneal nerves of both sides being transected one year later were divided into four groups randomly: the degeneration group and regeneration of 1, 3 and 5 months groups. Another 4 rabbits were used for control. All transected common peroneal nerves underwent epineural suture except for the degeneration group the electrophysiological examination was carried out at 1, 3 and 5 months postoperatively. Retrograde labelling of the anterior horn cells was demonstrated and the cells were observed under light and electronmicroscope. RESULTS 1. The number of labelled anterior horn cell in the spinal cord was 45% of the normal population after denervation for one year (P lt; 0.01). The number of labelled cells increased steadily from 48% to 57% and 68% of normal values at 1, 3 and 5 months following delayed nerve repair (P lt; 0.01). 2. The ultrastructure of the anterior horn cells of the recover gradually after repair. 3. With the progress of regeneration the latency become shortened, the conduction velocity was increased, the amplitude of action potential was increased. CONCLUSION Following delayed repair of injury of peripheral nerve, the morphology of anterior horn cells of spinal cord and electrophysiological display all revealed evidence of regeneration, thus the late repair of injury of peripheral nerve was valid.
Ten, fifteen and twenty millimeter nerve defects were produced on both trunks of sciatic nerve in 18 rabbits. The stumps of the nerve were enclosed by a silicon tube in the right hind limb (slilcon group) and the left limbs were free (free group). The proximal and distal nerve stumps in both groups were elongated by using a selfdesigned nerve stretching device, and the nerve were gradually stretched by 1mm, 2mm and 3mm per day respectively. when the expected lengths were achieved, the defects of the nerve were managed by endtoend coaptation. The samples were analysed by electrophysiological examination, and light and electron microscopes. Results were as follows: (1) The nerve defect could be repaired by gradual elongation in rabbits; (2) The results of silicon group were superior to the free group; (3) The structure and microcirculation of the nerve would be damaged if the stretching speed exceeded the limit of 2mm per day. But the eventual results following repair by elongation could not reached the normal level.
The biomaterial, chitin, was used to create a nerve regeneration chamber for bridging healing experiment of sciatic nerve of rats having a defect of 12mm. The crude Schwann cells were introduced into the chambers in one group and the other group had no crude Schwann cells in the chamber and the results of the two groups were compared with those having the nerve defects bridged with skeletal muscles. The specimens were observed by macroscopic, microdissection. electrophysiologic testing, HRP retrograde labelling, histologic and electron microscopic examinations at 4, 8, and 12 weeks after the operation. The results showed that atthe 8th week, the regenerating nerve fibers from the cephalad ends had united with the fibers of the caudal ends of the divided nerves either the crude Schwanneclls were introduced or not, but the morphology of the regenerating nerve, the way of regeneration and the recovery of the function of the extremities were far superior in the group that no cruds Schwann cells had been introduced than those with crude Schwann cell introduced and those bridged by skeletal muscles.
In order to enhance the therapeutic effectiveness of peripheral nerve injury, intraoperative extrab electrical stimulation was used in peripheral nerve surgery. In 16 cases of incomplete peripheral rnerve injuries or poorly regeneratedn erves, continuous intraoperative electrophysiological monitoring was used for guidance of neurolysis. Meanwhile, extrastong electrical stimulation was applied. The latency and amplitude before and after electrical stimulation were recorded and the extent of improrement was compared. In all cases, the latency and amplitude were improved after neurolysis and electrical stimulation. Clinical follow-up also showed that the function of corresponding innorvated muscle was improved. Continuous intraoperative extrab electrical stimulation could be used as an practical measure to increase the effectiveness of peripheral nerve treatment.
Objective To investigate the effect of extract of ginkgo biloba leaves (EGb50) on the prol iferation of SCs cultured in vitro. Methods The SCs were isolated from 3-day-old SD rats’ sciatic nerves by the method of enzyme gradationdigestion (n=20) and the purified 2nd passage of SCs were divided into 2 groups: the experimental group, in which SCs were cultured in FBS-DMEM medium with EGb50 (terminal concentration: 50 μg/mL); the control group, in which SCs were cultured in the FBS-DMEM medium without EGb50. The absorbance (A) value was detected by the 2, 3-bis- (2-methoxy-4-nitro-5- sulfophenyl)-2H-tetrazol ium-5-carboxanil ide (XTT) method 1, 3, 5, 7 and 9 days after culture, then the growth curves was drawn. Cell cycle was detected by flow cytometry (FCM). Disintegration per minute (DPM) of SCs was detected by the method of 3H-thymine nucleoside (3H-TdR) 2 and 3 days after culture and nerve growth factor (NGF) synthesis in SCs culture media was detected by ELISA method. Results Most SCs were spindle-shaped with a purity above 90%. XTT detection showed that A value of SCs in the control group was gradually increased 3 days after culture, reached the peak 5 days after culture and gradually decreased from then; the A value in the experimental group experienced the similar changes, but it was higher than that in the control group at each time point (P lt; 0.01). 3H-TdR showed that the DPM of the experimental group was 1 961.78 ± 231.13 and 4 601.51 ± 605.08 at 2 and 3 days after culture, while for the control group, the A value was 1 347.15 ± 121.57 and 3 740.42 ± 158.73 at the same time point, indicating a significant difference between two groups (P lt; 0.01). FCM observation indicated that the SCs prol iferation index of the experimental group and the control group was 18.6% ± 3.2% and 9.7% ± 2.9%, indicating a significant difference between two groups (P lt; 0.01). ELISA observation showed that the NGF concentration in the experimental and the control group was (0.065 6 ± 0.003 9) ng/mL and (0.038 6 ± 0.003 6) ng/mL, indicating a significant difference (P lt; 0.01). Conclusion EGb50 is capable of enhancing the prol iferation of SCs cultured in vitro, which may be one of the important mechanisms to promote peripheral nerve regeneration.
Basing on the experimental results, 48 nerve defects (with the length of 3-4 cm in 21 cases, 4.1-5cm in 25 cases and 6cm in 2 cases) were repaired clinically by using vaseularized nerve sheath canal with living Schwann s cells, 87.5 percent of them obtained good results. The advantages were: (1) The neural sheath had rich blood supply with resultant less scar from its healing; (2) The living Schwann s cells would secrete somatomedin to promote the reproduction of neural tissues; and (3) The useless neurofib...
OBJECTIVE: To study the effects of Schwann cell cytoplasmic derived neurotrophic proteins (SDNF) on the regeneration of peripheral nerve in vivo. METHODS: Ninety adult SD rats were chosen as the experimental model of degenerated muscle graft with vascular implantation bridging the 10 mm length of right sciatic nerve. They were divided randomly into three groups, 30 SD rats in each groups. 25 microliters of 26 ku SDNF (50 micrograms/ml, group A), 58 ku SDNF (50 micrograms/ml, group B) and normal saline(group C) were injected respectively into the proximal, middle and distal part of the degenerated muscle grafts at operation, 7 and 14 days postoperatively. The motorial function recovery assessment was carried out every 15 days with the sciatic nerve function index(SFI) after 15 days to 6 months of operation. Histological and electrophysiological examination of regenerating nerve were made at 1, 3 and 6 months postoperatively. RESULTS: There were significant statistic differences between the both of experimental groups(group A and B) and control group(group C) in the respects of the histological, electrophysiological examination and SFI(P lt; 0.01). CONCLUSION: The 26 ku SDNF and 58 ku SNDF can improve the regeneration of the injured peripheral nerve in vivo.
In order to obtain the anatomical basis of transferring the anterior interosseous nerve to repair the injury of thenar or ulnar nerve at the wrist level, ten fresh cadaveric forearms were dissected. The pronator quadratus branch of the median nerve was (1.5 +/- 0.4) mm in diameter with (866 +/- 144) nerve fibers. The recurrent branch of median nerve was (1.7 +/- 0.3) mm in diameter with (1,120 +/- 97) nerve fibers. The deep branch of ulnar nerve was (2.1 +/- 0.4) mm in diameter with (1,318 +/- 120) nerve fibers. To repair the thenar recurrent branch, nerve graft should be used to bridge between the distal end of the anterior interosseous nerve and the origination of the recurrent branch. The deep branch of the ulnar nerve could be repaired by direct suture after being dissected proximally. In patients, the technique was applied to repair 17 cases of injury of thenar branch and 3 cases of injury of deep branch of ulnar nerve. Among them, seventeen cases were followed up from 2 to 7 years. On electromyogram it was normal in 10. The myodynamia was restored in different degree: M2 in 2, M3 in 5, M4 in 7, M5 in 3. The procedure of the operation and the matters needed attention during the operation were discussed.
OBJECTIVE: To investigate the effect of olfactory ensheathing cells (OECs) on functional recovery after sciatic nerve injury. METHODS: Upon silicone-tubulization of transected sciatic nerve in 30 adult rats. Thirty rats were divided into two groups(SAL group and OECs group); saline and OECs were injected into the silicone chamber in SAL group and in OECs group respectively. The status of functional recovery of injured sciatic nerve was observed by electrophysiological analysis, axon morphometry analysis. RESULTS: In OECs group on the 30th and the 90th days after sciatic nerve transection: 1. The latent period of CMAP shortened by 0.60 ms and 0.56 ms; the nerve conduction velocity promoted by 6.42 m/s and 5.36 m/s; the amplitude enhanced by 3.92 mv and 5.84 mv, respectively; 2. The HRP positive cells in lateral nucleus of spinal anterior horn increased by 11.63% and 25.01%; 3. The number of nerve fibers increased by 1,047/mm2 and 1,422/mm2 and the thickness of myelim sheath increased by 0.43 micron and 0.63 micron, respectively. CONCLUSION: The olfactory ensheathing cells are capable of promoting the functional recovery after peripheral nerve injury.