Partial return of motor function in paralyzed legs after surgical bypass of the lesion site by nerve autografts three years after spinal cord injury.
Partial return of motor function in paralyzed legs after surgical bypass of the lesion site by nerve autografts three years after spinal cord injury.
复制标题
脊髓损伤三年后，通过自体神经移植手术绕过病变部位后，瘫痪腿的运动功能部分恢复。
DOI：
10.1089/089771502320317069
复制
发表时间：
2002
影响因子：
4.2
通讯作者：
J. Mathé
中科院分区：
文献类型：
--
作者：
M. Tadié;S. Liu;R. Robert;Pierre Guihéneuc;Yann Péréon;B. perrouin‐verbe;J. Mathé
脊髓损伤通常导致损伤水平以下的运动和躯体感觉功能的不可逆丧失。治疗仅限于旨在补偿残疾的物理疗法。我们以前表明，在动物模型中，通过在头侧脊髓腹角和尾侧腹根之间植入自体神经移植物，可以实现组织连续性的重建。因此，嘴侧运动神经元轴突可以到达外周目标，导致运动功能的一些恢复。我们在一位T9节段脊髓创伤性损伤三年后临床状态稳定的截瘫患者中使用了类似的方法。将3段自体腓肠神经分别植入T7-8节段脊髓的左右前外侧象限，然后分别与同侧L2-4腰前根相连。术后8个月，观察双侧内收肌和左侧股四头肌的自主收缩。通过对尝试肌肉收缩的运动单位电位确认肌肉活动。通过经颅磁刺激记录这些肌肉的运动诱发电位。这些数据支持这一假设，即肌肉已重新连接到脊髓上的中心，通过运动神经元位于喙残端受损的脊髓。他们认为延迟手术重建运动通路可能有助于部分功能恢复。
Spinal cord injuries often result in irreversible loss of motor and somatosensory functions below the lesion level. Treatment is limited to physiotherapy aimed at compensating disability. We previously showed that re-establishment of tissue continuity can be achieved in animal models through nerve autografts implanted between the rostral spinal ventral horn and the caudal ventral roots. Rostral motor neuron axons could thus reach peripheral targets, leading to some return of motor function. We used a similar approach in a paraplegic patient with stabilized clinical states three years after spinal cord traumatic damage at the T9 level. Three segments from autologous sural nerves were implanted into the right and left antero-lateral quadrant of the cord at T7-8 levels, then connected to homolateral L2-4 lumbar ventral roots, respectively. Eight months after surgery, voluntary contractions of bilateral adductors and of the left quadriceps were observed. Muscular activity was confirmed by motor unit potentials in response to attempted muscle contraction. Motor-evoked potentials from these muscles were recorded by transcranial magnetic stimulation. These data support the hypothesis that muscles have been re-connected to supra-spinal centers through motor neurons located in the rostral stump of the damaged cord. They suggest that delayed surgical reconstruction of motor pathways may contribute to partial functional recovery.