CAJ | 학술논문

目的探讨利用脊髓损伤平面以上正常的脊神经前根与支配股四头肌的优势腰神经前根吻合,重建脊髓损伤大鼠的股四头肌神经通路,恢复脊髓损伤大鼠肢体部分运动功能的效果.方法取4周龄SD大鼠20只,体重120～150 g;左侧为实验侧,右侧为对照侧.将大鼠左侧L1～L5脊神经根分别进行电刺激,根据股四头肌肌电图的检测结果,得出支配股四头肌优势神经根.将左侧L1神经前根与股四头肌优势脊神经前根通过尾神经桥接吻合,重建大鼠股四头肌的神经通路,右侧不作任何处理.术后6个月,在切断左侧L2脊髓水平制备大鼠脊髓损伤模型前后,分别进行电生理检测,饲养4周后进行电刺激大鼠股四头肌运动情况观察,BBB评分及后肢运动观察.结果 16只大鼠存活至术后6个月,10只大鼠成功分离出吻合的神经根,获得实验结果.实验侧截瘫前、后,单相方波(2.5 mA,0.2ms,1 Hz)刺激神经吻合段,均可记录到股四头肌动作电位,波幅分别为(7.63±1.86)mV和(6.00±1.92)mV,差异无统计学意义(P＞0.05);对照侧截瘫后电刺激L3脊神经根,引出的股四头肌动作电位波幅为(15.87±1.16)mV,均大于实验侧截瘫前后股四头肌动作电位波幅(P＜0.05).截瘫后饲养4周,观察大鼠实验侧后肢平地能完成爬行动作,登高时能完成攀高动作;截瘫后1、3、7、14、21、28 d观察后肢运动功能的BBB评分,BBB评分值在伤后1、3、7 d时间点差异均有统计学意义(P＜0.05),在14、21、28 d时间点差异无统计学意义.结论利用截瘫平面以上健存的脊神经根,通过尾神经桥接吻合股四头肌优势支配神经根,可建立股四头肌新的脊髓旁神经通路,有望实现截瘫患者下肢部分的运动功能.
목적 탐토이용척수손상평면이상정상적척신경전근여지배고사두기적우세요신경전근문합,중건척수손상대서적고사두기신경통로,회복척수손상대서지체부분운동공능적효과.방법취4주령SD대서20지,체중120～150 g;좌측위실험측,우측위대조측.장대서좌측L1～L5척신경근분별진행전자격,근거고사두기기전도적검측결과,득출지배고사두기우세신경근.장좌측L1신경전근여고사두기우세척신경전근통과미신경교접문합,중건대서고사두기적신경통로,우측불작임하처리.술후6개월,재절단좌측L2척수수평제비대서척수손상모형전후,분별진행전생리검측,사양4주후진행전자격대서고사두기운동정황관찰,BBB평분급후지운동관찰.결과 16지대서존활지술후6개월,10지대서성공분리출문합적신경근,획득실험결과.실험측절탄전、후,단상방파(2.5 mA,0.2ms,1 Hz)자격신경문합단,균가기록도고사두기동작전위,파폭분별위(7.63±1.86)mV화(6.00±1.92)mV,차이무통계학의의(P＞0.05);대조측절탄후전자격L3척신경근,인출적고사두기동작전위파폭위(15.87±1.16)mV,균대우실험측절탄전후고사두기동작전위파폭(P＜0.05).절탄후사양4주,관찰대서실험측후지평지능완성파행동작,등고시능완성반고동작;절탄후1、3、7、14、21、28 d관찰후지운동공능적BBB평분,BBB평분치재상후1、3、7 d시간점차이균유통계학의의(P＜0.05),재14、21、28 d시간점차이무통계학의의.결론 이용절탄평면이상건존적척신경근,통과미신경교접문합고사두기우세지배신경근,가건립고사두기신적척수방신경통로,유망실현절탄환자하지부분적운동공능.
Objective To establish a paraspinal neural pathway of quadriceps femoris by end-to-end anastomoses between the spinal ventral root after spinal cord injury(SCI) in rats. Methods Twenty-fourweek old SD rats, with the weight of 120 g to 150 g, were included. The left side was the experimental side, while the right side served as a control. Electrostimulating of L1-L5 ventral root was done respectively to decide the predominant nerve of quadriceps femoris. The lumbar 1 ventral root was reveal to little innervation of quadriceps femoris, and the lumbar 3 ventral root was predominant innervation. End-to-end anastomosis between the left L1 and L3 ventral root was done. After axona regeneration, the new paraspinal neural pathway of quadriceps femoris was established. At 6 months postoperatively, the early function of the new pathway was observed by electrophysiological examinations, hindlimb locomotion and BBB (basso, beattie and bresnahan)scale at 1,3,7, 14,21,28 d after SCI. Results Sixteen rats survived for 6 months after operation and only ten rats got good results because of tissue adhesion postoperatively. Single stimuli (2.5 mA,0.2 ms, 1 Hz) of the left anastomoses nerve resulted in action potential recorded from the left quadriceps femoris before and after the spinal cord hemisection horizontally between L2 segmental levels. The amplitudes of the action potentials were (7.63 ± 1.86) mV and (6.00 ± 1.92)mV, respectively, and there was no significant difference (P ＞ 0.05). The left quadriceps femoris contraction was initiated by single stimuli (2.5mA, 0.2 ms, 1 Hz) of the left anastomoses nerve. After paraplegia, when the right L3 ventral root was stimulated, the amplitude of the action potential was (15.87 ± 1.16) mV. Locomotion of the left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. According to BBB scale, there was significant difference at 1, 3, 7 d, and little difference at 14, 21, 28 d after SCI. Conclusion Spinal ventral roots cross-ananstomosis to reconstruct the paraspinal pathway of quadriceps femoris after SCI is efficient reinnervation of hindlamb muscles in a rat model and may have potential in clinical application.