目的 制备神经生长因子(NGF)梯度缓释系统,并探讨其促进周围神经再生的临床疗效. 方法 对2010年7月至2012年8月收治的57例周围神经损伤患者进行一期神经修复,同时随机分为A组(19例)、B组(19例)及C组(19例),A组患者利用自制的梯度缓释系统进行NGF局部缓释,B组患者利用等量的NGF在神经周同明胶海绵包绕后局部注射,C组患者仅进行神经显微缝合,未行NGF注射,4周及8周后分别进行神经电生理检查,比较组间体感诱发电位(SEP)、肌肉动作电位(MAP)的变化,并对神经传导速度(NCV)作进一步分析;24周后分别行BMRC感觉及运动功能评定标准评分. 结果 术后4周,A、B、C组SEP峰潜时分别为(34.80±3.45)、(42.85 ±2.58)、(51.05±3.652) ms,三组波幅分别为(10.673±2.35)、(6.30±1.22)、(4.10 ±0.83)μV;A、B、C组MAP峰潜时分别为(5.29±0.82)、(7.63±1.35)、(9.98 ±1.15)ms,三组波幅分别为(485.75±65.83)、(262.510±59.90)、(185.64±38.35) μV;A、B、C组的NCV分别为(25.50±3.65)、(19.80±2.35)、(15.50±2.61)m/s.术后8周,A、B、C组SEP峰潜时分别为(24.68±4.50)、(31.08±4.24)、(39.25±4.83)ms,三组波幅分别为(21.22±4.63)、(13.68 ±4.14)、(8.90±1.25) μV,A、B、C 三组MAP峰潜时分别为(4.7l±0.35)、(6.10±1.54)、(8.86±0.75) ms,三组波幅分别为(839.81±111.07)、(512.25±46.82)、(312.65 ±47.52) μV,三组的NCV分别为(26.24±3.22)、(21.23±2.40)、(16.34±2.55) m/s;与C组相比,A、B组SEP、MAP峰潜时明显缩短,波幅明显增高,NCV明显增快,差异有统计学意义(P＜0.05),与B组相比,A组SEP、MAP峰潜时明显缩短,波幅明显增高,NCV明显增快,差异有统计学意义(P ＜0.05);BMRC感觉功能评分巾,A、B、C 三组的优良率分别为78.95％、63.15％、52.63％;运动功能评定巾,A、B、C 三组的优良率分别为84.21％、68.42％、47.37％;A、B组优良率均高于C组,其中A组优良率高于B组,差异均有统计学意义(P＜0.05). 结论 NGF梯度缓释系统可早期安全、有效地促进周围神经损伤修复后的功能恢复.
目的 製備神經生長因子(NGF)梯度緩釋繫統,併探討其促進週圍神經再生的臨床療效. 方法 對2010年7月至2012年8月收治的57例週圍神經損傷患者進行一期神經脩複,同時隨機分為A組(19例)、B組(19例)及C組(19例),A組患者利用自製的梯度緩釋繫統進行NGF跼部緩釋,B組患者利用等量的NGF在神經週同明膠海綿包繞後跼部註射,C組患者僅進行神經顯微縫閤,未行NGF註射,4週及8週後分彆進行神經電生理檢查,比較組間體感誘髮電位(SEP)、肌肉動作電位(MAP)的變化,併對神經傳導速度(NCV)作進一步分析;24週後分彆行BMRC感覺及運動功能評定標準評分. 結果 術後4週,A、B、C組SEP峰潛時分彆為(34.80±3.45)、(42.85 ±2.58)、(51.05±3.652) ms,三組波幅分彆為(10.673±2.35)、(6.30±1.22)、(4.10 ±0.83)μV;A、B、C組MAP峰潛時分彆為(5.29±0.82)、(7.63±1.35)、(9.98 ±1.15)ms,三組波幅分彆為(485.75±65.83)、(262.510±59.90)、(185.64±38.35) μV;A、B、C組的NCV分彆為(25.50±3.65)、(19.80±2.35)、(15.50±2.61)m/s.術後8週,A、B、C組SEP峰潛時分彆為(24.68±4.50)、(31.08±4.24)、(39.25±4.83)ms,三組波幅分彆為(21.22±4.63)、(13.68 ±4.14)、(8.90±1.25) μV,A、B、C 三組MAP峰潛時分彆為(4.7l±0.35)、(6.10±1.54)、(8.86±0.75) ms,三組波幅分彆為(839.81±111.07)、(512.25±46.82)、(312.65 ±47.52) μV,三組的NCV分彆為(26.24±3.22)、(21.23±2.40)、(16.34±2.55) m/s;與C組相比,A、B組SEP、MAP峰潛時明顯縮短,波幅明顯增高,NCV明顯增快,差異有統計學意義(P＜0.05),與B組相比,A組SEP、MAP峰潛時明顯縮短,波幅明顯增高,NCV明顯增快,差異有統計學意義(P ＜0.05);BMRC感覺功能評分巾,A、B、C 三組的優良率分彆為78.95％、63.15％、52.63％;運動功能評定巾,A、B、C 三組的優良率分彆為84.21％、68.42％、47.37％;A、B組優良率均高于C組,其中A組優良率高于B組,差異均有統計學意義(P＜0.05). 結論 NGF梯度緩釋繫統可早期安全、有效地促進週圍神經損傷脩複後的功能恢複.
목적 제비신경생장인자(NGF)제도완석계통,병탐토기촉진주위신경재생적림상료효. 방법 대2010년7월지2012년8월수치적57례주위신경손상환자진행일기신경수복,동시수궤분위A조(19례)、B조(19례)급C조(19례),A조환자이용자제적제도완석계통진행NGF국부완석,B조환자이용등량적NGF재신경주동명효해면포요후국부주사,C조환자부진행신경현미봉합,미행NGF주사,4주급8주후분별진행신경전생리검사,비교조간체감유발전위(SEP)、기육동작전위(MAP)적변화,병대신경전도속도(NCV)작진일보분석;24주후분별행BMRC감각급운동공능평정표준평분. 결과 술후4주,A、B、C조SEP봉잠시분별위(34.80±3.45)、(42.85 ±2.58)、(51.05±3.652) ms,삼조파폭분별위(10.673±2.35)、(6.30±1.22)、(4.10 ±0.83)μV;A、B、C조MAP봉잠시분별위(5.29±0.82)、(7.63±1.35)、(9.98 ±1.15)ms,삼조파폭분별위(485.75±65.83)、(262.510±59.90)、(185.64±38.35) μV;A、B、C조적NCV분별위(25.50±3.65)、(19.80±2.35)、(15.50±2.61)m/s.술후8주,A、B、C조SEP봉잠시분별위(24.68±4.50)、(31.08±4.24)、(39.25±4.83)ms,삼조파폭분별위(21.22±4.63)、(13.68 ±4.14)、(8.90±1.25) μV,A、B、C 삼조MAP봉잠시분별위(4.7l±0.35)、(6.10±1.54)、(8.86±0.75) ms,삼조파폭분별위(839.81±111.07)、(512.25±46.82)、(312.65 ±47.52) μV,삼조적NCV분별위(26.24±3.22)、(21.23±2.40)、(16.34±2.55) m/s;여C조상비,A、B조SEP、MAP봉잠시명현축단,파폭명현증고,NCV명현증쾌,차이유통계학의의(P＜0.05),여B조상비,A조SEP、MAP봉잠시명현축단,파폭명현증고,NCV명현증쾌,차이유통계학의의(P ＜0.05);BMRC감각공능평분건,A、B、C 삼조적우량솔분별위78.95％、63.15％、52.63％;운동공능평정건,A、B、C 삼조적우량솔분별위84.21％、68.42％、47.37％;A、B조우량솔균고우C조,기중A조우량솔고우B조,차이균유통계학의의(P＜0.05). 결론 NGF제도완석계통가조기안전、유효지촉진주위신경손상수복후적공능회복.
Objective To prepare nerve growth factor gradient release system,and explore the promotion of the clinical effects of peripheral nerve regeneration.Methods All 57 cases with peripheral nerve injuries were treated with emergency nerve repair from July 2010 to August 2012,a nerve repair,with meanwhile randomly were divided into group A (19 cases),group B (19 cases) and group C (19 cases).The NGF was used to partial release by using the homemade gradient release system in group A,the same amount of NGF was partial injeced to Gelatin sponge surrounding peripheral nerve in group B.The NGF wasn't injected in group C.All patients respectively underwent neurophysiological examination after 4 weeks and 8 weeks.Comparising with the somatosensory evoked potentials (SEP) and muscle action potential (MAP) between different groups,meanwhile analyzing nerve conduction velocity (NCV).The sensory and motor function evaluation score of BMRC were performed after 24 weeks.Results The peak latency of the SEP after 4 weeks in A,B and C groups were (34.80 ± 3.45) ms,(42.85 ± 2.58) ms,and (51.05 ±3.652) ms,respectively; the volatility were (10.673 ± 2.35) μV,(6.30 ± 1.22) μV,and (4.10 ±0.83) μV,the peak latency of the MAP after 4 weeks in A,B,C groups were(5.29 ±0.82) ms,(7.63 ± 1.35)ms,and (9.98 ± 1.15) ms,the volatility were (485.75 ±65.83) μV,(262.510 ±59.90) μV,and (185.64 ±38.35) μV,the NCV were (25.50 ±3.65) m/s,(19.80±2.35) m/s,and (15.50 ±2.61) m/s.The peak latency of the SEP after 8 weeks in A,B,C groups were (24.68 ±4.50) ms,(31.08 ±4.24) ms,and (39.25 ±4.83) ms,the volatility were (21.22 ± 4.63) μV,(13.68 ± 4.14) μV,and (8.90 ± 1.25) μV.The peak latency of the MAP after 8 weeks in A,B,C groups were (4.71 ±0.35) ms,(6.10±1.54) ms,and (8.86±0.75) ms,the volatility were (839.81 ± 111.07) μv,(512.25 ±46.82) μv,and (312.65 ±47.52) μv,the NCV were (26.24±3.22) m/s,(21.23 ±2.40) m/s,and (16.34 ±2.55) m/s.Compared with the group C,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A and B,the NCV was faster significantly in group A and B (P ＜ 0.05).Compared with the group B,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A,the NCV was faster significantly in group A (P ＜ 0.05).The good rate of the A,B,C groups in BMRC sensory function score were 78.95％,63.15％ and 52.63％ respectively.The good rate in BMRC motor function score were 84.21％,68.42％and 47.37％ respectively.The group A and B were higher than group C,and the good rate of group A was higher than group B(P ＜ 0.05).Conclusion The nerve growth factor gradient release system is safe and effective for early treatment of peripheral nerve injuries.
