中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
1期
74-76
,共3页
杨润功%衷鸿宾%朱加亮%左坦坦%吴克俭%侯树勋
楊潤功%衷鴻賓%硃加亮%左坦坦%吳剋儉%侯樹勛
양윤공%충홍빈%주가량%좌탄탄%오극검%후수훈
去细胞神经%移植,同种%周围神经
去細胞神經%移植,同種%週圍神經
거세포신경%이식,동충%주위신경
Acellular nerve allograft%Transplantation,homologous%Peripheral Nerves
目的 探讨化学去细胞同种异体神经移植修复人体周围神经缺损的临床安全性.方法 从2002年3月至2011年1月,取成年遗体捐献者的周围神经,使用化学萃取法制备去细胞同种异体神经,将其消毒、储存,并用于临床治疗41例周围神经缺损患者.男性38例,女性3例,年龄10~55岁.受伤至神经修复时间10 h至9个月,平均4.1个月.受损神经包括臂丛神经10例,上臂桡神经3例,前臂尺神经4例,指(趾)神经12例,坐骨神经2例,胫神经3例,腓总神经5例,股神经2例.合并骨折12例,合并软组织损伤或缺损20例.神经桥接长度2~10 cm,平均6.1 cm.术后不使用免疫抑制药物.术后随访9~5l个月,平均20.2个月.通过手术部位物理检查及血生化和免疫检测以评价移植的安全性.结果 术后患者全部得到随访,39例伤口一期愈合,2例发生表浅感染,经换药后延迟愈合.所有患者均未发生免疫排斥反应、过敏性反应、深部感染、肝肾毒副作用等不良反应.术后1、12周血生化检测均正常,特种蛋白、淋巴细胞亚群等免疫检测指标术前、术后差异无统计学意义.结论 临床上采用去细胞同种异体神经移植修复人体周围神经缺损是安全的.
目的 探討化學去細胞同種異體神經移植脩複人體週圍神經缺損的臨床安全性.方法 從2002年3月至2011年1月,取成年遺體捐獻者的週圍神經,使用化學萃取法製備去細胞同種異體神經,將其消毒、儲存,併用于臨床治療41例週圍神經缺損患者.男性38例,女性3例,年齡10~55歲.受傷至神經脩複時間10 h至9箇月,平均4.1箇月.受損神經包括臂叢神經10例,上臂橈神經3例,前臂呎神經4例,指(趾)神經12例,坐骨神經2例,脛神經3例,腓總神經5例,股神經2例.閤併骨摺12例,閤併軟組織損傷或缺損20例.神經橋接長度2~10 cm,平均6.1 cm.術後不使用免疫抑製藥物.術後隨訪9~5l箇月,平均20.2箇月.通過手術部位物理檢查及血生化和免疫檢測以評價移植的安全性.結果 術後患者全部得到隨訪,39例傷口一期愈閤,2例髮生錶淺感染,經換藥後延遲愈閤.所有患者均未髮生免疫排斥反應、過敏性反應、深部感染、肝腎毒副作用等不良反應.術後1、12週血生化檢測均正常,特種蛋白、淋巴細胞亞群等免疫檢測指標術前、術後差異無統計學意義.結論 臨床上採用去細胞同種異體神經移植脩複人體週圍神經缺損是安全的.
목적 탐토화학거세포동충이체신경이식수복인체주위신경결손적림상안전성.방법 종2002년3월지2011년1월,취성년유체연헌자적주위신경,사용화학췌취법제비거세포동충이체신경,장기소독、저존,병용우림상치료41례주위신경결손환자.남성38례,녀성3례,년령10~55세.수상지신경수복시간10 h지9개월,평균4.1개월.수손신경포괄비총신경10례,상비뇨신경3례,전비척신경4례,지(지)신경12례,좌골신경2례,경신경3례,비총신경5례,고신경2례.합병골절12례,합병연조직손상혹결손20례.신경교접장도2~10 cm,평균6.1 cm.술후불사용면역억제약물.술후수방9~5l개월,평균20.2개월.통과수술부위물리검사급혈생화화면역검측이평개이식적안전성.결과 술후환자전부득도수방,39례상구일기유합,2례발생표천감염,경환약후연지유합.소유환자균미발생면역배척반응、과민성반응、심부감염、간신독부작용등불량반응.술후1、12주혈생화검측균정상,특충단백、림파세포아군등면역검측지표술전、술후차이무통계학의의.결론 림상상채용거세포동충이체신경이식수복인체주위신경결손시안전적.
Objective To discuss the clinical safety about repairing the peripheral nerve defects with the acellular allogeneic nerve.Methods The 41 patients (male 38,female 3,age 10-55 years old,average 28.9 years old) who were performed chemically extracted acellular nerve allograft transplanting to repair nerve defects from 2002 to 2011.The average interval from injury to nerve repairing was 4.1 months (range,10 hours to 9 months).There were 41 cases nerve defects including 10 brachial plexus nerves,3 radial nerves of upper arm,4 ulnar nerves of forearm,12 digital and toe nerves,2 sciatic nerves,2femoral nerves,3 tibial nerves and 5 common peroneal nerves.There were 12 cases combinated fractures and 20 soft tissue injury or defects.The average length of the nerve allograft to bridge the nerve defects was 6.1cm (range,2-10 cm).No immunosuppressive drugs were used in all cases.The clinical safety was evaluated through physical examination,blood biochemistry and immunity detection.Results All cases were followed up post-operation.They got primary wound healing except 2 superficial infection who got delay healing through dressings changing.No any adverse effects happened including immunological rejection,hypersensitivity reaction,deep infection,hepatotoxicity and ephrotoxicity.Conclusions It is safe and feasible to repairing human peripheral nerve defects with chemically extracted acellular nerve allograft.