Functional Recovery after the Repair of Transected Cervical Roots in the Chronic Stage of Injury
Functional Recovery after the Repair of Transected Cervical Roots in the Chronic Stage of Injury
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DOI：
10.1089/neu.2008.0529
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发表时间：
2009-10-01
影响因子：
4.2
通讯作者：
Cheng, Henrich
中科院分区：
文献类型：
--
作者：
Huang, Ming-Chao;Lo, Ming-Jei;Cheng, Henrich
根损伤的治疗通常在损伤后的更慢性阶段进行，此时大量的神经元已经死亡。因此，在应用于临床之前，这些病变的治疗策略应证明在损伤的慢性阶段与急性阶段一样有效。在这项研究中，我们模拟了最严重的临床情况，以建立慢性阶段修复的最佳时间窗。在雌性SD大鼠左侧第6 ~ 8颈神经根与脊髓连接处切断。一周或三周后，重新打开伤口，用肋间神经移植物修复这些神经根，随后应用aFGF和纤维蛋白胶。在对照组中，伤口在再次探查后闭合，未进行进一步的修复手术。术后测量感觉和运动功能。用CTB-HRP追踪脊髓形态、神经元存活和神经纤维再生。结果显示，修复1周组感觉和运动功能均明显恢复，而修复3周组感觉和运动功能恢复不明显。CTB-HRP示踪发现，修复1周组脊髓结构相对完整，而对照组脊髓结构明显萎缩。修复1周组脊髓背角有再生神经纤维，运动神经元存活率高于修复3周组。得出的结论是，在慢性阶段用显微外科神经移植和应用aFGF和纤维蛋白胶治疗横断的颈神经根可以导致显著的功能恢复，只要在太多神经元死亡之前完成修复。
The treatment of root injury is typically performed at the more chronic stages post injury, by which time a substantial number of neurons have died. Therefore, before being applied in the clinical setting, a treatment strategy for these lesions should prove to be as effective in the chronic stages of injury as it is in the acute stage. In this study, we simulated the most severe clinical scenarios to establish an optimal time window for repair at a chronic stage. The sixth to eighth cervical roots on the left side of female SD rats were cut at their junction with the spinal cord. One or three weeks later, the wound was reopened and these roots were repaired with intercostal nerve grafts, with subsequent application of aFGF and fibrin glue. In the control group, the wound was closed after re-exploration without further repair procedures. Sensory and motor functions were measured after the surgery. Spinal cord morphology, neuron survival, and nerve fiber regeneration were traced by CTB-HRP. Results showed that both the sensory and motor functions had significant recovery in the 1-week repair group, but not in the 3-week repair group. By CTB-HRP tracing, we found that the architecture of the spinal cords was relatively preserved in the 1-week repair group, while those of the control group showed significant atrophic change. There were regenerating nerve fibers in the dorsal horn and more motor neuron survival in the 1-week repair group compared to that of the 3-week group. It was concluded that treating transected cervical roots at a chronic stage with microsurgical nerve grafting and application of aFGF and fibrin glue can lead to significant functional recovery, as long as the repair is done before too many neurons die.