CAJ | 학술논문

背景:通过改变脊髓损伤局部环境的方法,能够促使损伤的神经修复、再生和恢复脊髓部分神经功能.嗅鞘细胞移植能够改善脊髓损伤的局部内环境.目的:探讨嗅鞘细胞移植治疗对陈旧性脊髓损伤患者脊髓及神经功能修复的作用及安全性.设计:自身对照实验.单位:山东省泰安荣军医院外科病房.对象:纳入山东省荣军医院外科2004-06/2005-07收住院的陈旧性脊髓损伤患者48例.男39例,女9例;年龄7～59岁,平均36岁.方法:①细胞培养:取流产胎儿的嗅球消化成单个嗅鞘细胞,培养纯化1～2周,最后制成单细胞混悬液.②手术及细胞移植:在全麻下进行,将纯化好的嗅鞘细胞的单细胞悬液(约0.05～0.20 mL)用自制的直经0.45 mm的注射器分多点注射于相应脊髓损伤处,术后10～14 d伤口拆线.③脊髓功能评定:术前1 d及术后2周～2个月,采用美国脊髓损伤学会制订的脊髓损伤学会评分标准进行评分对比,并进行统计学处理.④术后3周～1年观察或电话随访48例患者脊髓功能情况.主要观察指标:①患者术后感觉功能变化.②患者术后运动功能的变化.③患者术后植物神经功能的变化.结果:①48例患者中均有脊髓功能的改善,且在术后3周～1年的观察或电话随访中仍呈继续改善的趋势.②感觉功能脊髓损伤学会评分术后高于术前(触觉:56.9,51.2,P＜0.01;痛觉:55.2,48.3,P＜0.01),感觉功能改善以感觉平面下移最明显,一般在两个节段以上.③运动功能脊髓损伤学会评分术后高于术前(44.8,40.7,P＜0.01),运动功能改善出现较慢.④植物神经功能脊髓损伤学会评分术后高于术前(18.0,14.5,P＜0.01),植物神经功能改善如:出汗、肠蠕动增加出现最早.结论:嗅鞘细胞移植对脊髓损伤晚期患者的脊髓及神经功能的恢复有促进作用,治疗方法安全.
배경:통과개변척수손상국부배경적방법,능구촉사손상적신경수복、재생화회복척수부분신경공능.후초세포이식능구개선척수손상적국부내배경.목적:탐토후초세포이식치료대진구성척수손상환자척수급신경공능수복적작용급안전성.설계:자신대조실험.단위:산동성태안영군의원외과병방.대상:납입산동성영군의원외과2004-06/2005-07수주원적진구성척수손상환자48례.남39례,녀9례;년령7～59세,평균36세.방법:①세포배양:취유산태인적후구소화성단개후초세포,배양순화1～2주,최후제성단세포혼현액.②수술급세포이식:재전마하진행,장순화호적후초세포적단세포현액(약0.05～0.20 mL)용자제적직경0.45 mm적주사기분다점주사우상응척수손상처,술후10～14 d상구탁선.③척수공능평정:술전1 d급술후2주～2개월,채용미국척수손상학회제정적척수손상학회평분표준진행평분대비,병진행통계학처리.④술후3주～1년관찰혹전화수방48례환자척수공능정황.주요관찰지표:①환자술후감각공능변화.②환자술후운동공능적변화.③환자술후식물신경공능적변화.결과:①48례환자중균유척수공능적개선,차재술후3주～1년적관찰혹전화수방중잉정계속개선적추세.②감각공능척수손상학회평분술후고우술전(촉각:56.9,51.2,P＜0.01;통각:55.2,48.3,P＜0.01),감각공능개선이감각평면하이최명현,일반재량개절단이상.③운동공능척수손상학회평분술후고우술전(44.8,40.7,P＜0.01),운동공능개선출현교만.④식물신경공능척수손상학회평분술후고우술전(18.0,14.5,P＜0.01),식물신경공능개선여:출한、장연동증가출현최조.결론:후초세포이식대척수손상만기환자적척수급신경공능적회복유촉진작용,치료방법안전.
BACKGROUND: Changing the local environment of spinal injury promotes the repair and regeneration of injured nerve and recovery of partial nervous function of spinal cord. Transplantation of olfactory ensheathing cells can improve the local internal environment of injured spinal cord.OBJECTIVE: To probe into the effect and safety of transplantation of olfactory ensheathing cells on functional repair of spinal cord and nerve in patients with obsolete spinal injury DESIGN: Self-control experiment.SETTING: Wards of the Department of Surgery, Taian Rongjun Hospital of Shandong Province.PARTICIPANTS: Totally 48 patients admitted for obsolete spinal injury in the Department of Surgery, Taian Rongjun Hospital, between June 2004 and July 2005 were recruited. There were 39 males and 9 females, aged 7 to 59 years with the mean of 36 years.METHODS: ①Cell culture: Olfactory bulb of aborted fetus was digested into single olfactory ensheathing cells, which were then cultured and puri fied for 1 to 2 weeks, and finally made into single cell suspension. ②Operation and cell transplantation: Under general anesthesia, the purified single cell suspension (about 0.05-0.20 mL) of olfactory ensheathing cells was injected into the corresponding spinal injury site through multiple points with home-made syringe of 0.45 mm in diameter. Stitches were taken out at postoperative 10 to 14 days. ③Evaluation of spinal function: Injury Scoring Standard made by American Spinal Injury Association (ASIA) was used for scoring, comparison and statistical analysis at postoperative 1 day and 2 weeks to 2 months. ④Spinal function of 48 patients was observed or followed up through telephone at postoperative 3 weeks to 1 year.MAIN OUTCOME MEASURES: Changes of postoperative sensory function of the patients. Changes of postoperative motor function of the patients. Changes of postoperative automatic nervous system of the patients.RESULTS: ①All the 48 patients had improvement in spinal function, and continued improved tendency was found in the observation and follow-up through telephone at postoperative 3 weeks to 1 year. ②Scoring by ASIA for sensory function was higher after operation than before operation (touch sensation: 56.9, 51.2, P ＜ 0.01; pain sensation: 55.2, 48.3, P ＜ 0.01). Sensory function was improved obviously at the lower shift of sensory level,generally more than 2 segments. ③Scoring by ASIA for motor function was higher after operation than before operation (44.8, 40.7, P ＜ 0.01), but the improvement was slow. ④Scoring by ASIA for automatic nervous system was higher after operation than before operation (18.0, 14.5, P ＜ 0.01); diaphoresis, increased enterokinesia and other automatic nervous system improved earliest.CONCLUSION: Transplantation of olfactory ensheathing cells promotes the spinal and neurofunctional recovery of patients with malignant spinal injury, and the therapeutic method is safe.