Reconstruction of sciatic nerve after traumatic injury in humans - factors influencing outcome as related to neurobiological knowledge from animal research.
Reconstruction of sciatic nerve after traumatic injury in humans - factors influencing outcome as related to neurobiological knowledge from animal research.
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DOI：
10.1186/1749-7221-7-7
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发表时间：
2012-10-10
影响因子：
0.7
通讯作者：
Dahlin LB
中科院分区：
文献类型：
--
作者：
Maripuu A;Björkman A;Björkman-Burtscher IM;Mannfolk P;Andersson G;Dahlin LB
目的是评估在治疗坐骨神经损伤患者时可以从大鼠模型中学到什么。对2例外伤性坐骨神经损伤患者进行了运动和感觉功能检查，并随访5年。分别于伤后第2天和第3天，取患侧腓肠神经移植修复神经损伤。对患者进行肌电(EMG)、核磁共振(MRI)和功能核磁共振(FMRI)检查，评估神经再支配、背根神经节(DRG)细胞死亡和皮质激活情况，以及与患者临床病史相关的因素。1例患者小腿和足部运动功能恢复良好，肌电图显示腿部肌肉活动良好，足部肌肉部分神经支配，足底部分感觉功能恢复。另一名患者腿部或足部没有运动(经肌电检查证实)或感觉功能。对两个病例的结果影响最大的因素是损伤类型、神经间隙长度和特别是重建类型。随访和康复方面的差异也可能影响结果。MRI显示患侧与健侧背根神经节大小无明显差异。功能磁共振成像显示初级躯体感觉皮质的正常激活是对正常足部皮肤刺激的反应。然而，在受伤的脚受到皮肤刺激后，两名患者的初级躯体感觉皮质都没有表现出任何激活。在神经修复和重建的决策中，来自动物实验的数据可以转化为临床实践并预测患者的结果，尽管此类数据应谨慎解释并与临床经验联系起来。大鼠模型可能有助于识别和研究影响周围神经修复和重建后结果的因素；应该正确地和有能力的团队一起进行的程序。然而，一些已知会影响神经修复后结果的因素，如认知能力和应对方式，很难在动物模型中进行研究。未来的研究必须找到和开发新的途径和技术来研究神经损伤后中枢神经系统的变化，并开发在康复过程中利用大脑可塑性的策略。
The aim was to evaluate what can be learned from rat models when treating patients suffering from a sciatic nerve injury. Two patients with traumatic sciatic nerve injury are presented with examination of motor and sensory function with a five-year follow-up. Reconstruction of the nerve injury was performed on the second and third day, respectively, after injury using sural nerve grafts taken from the injured leg. The patients were examined during follow-up by electromyography (EMG), MRI and functionalMRI (fMRI) to evaluate nerve reinnervation, cell death in dorsal root ganglia (DRG) and cortical activation; factors that were related to clinical history in the patients. One patient regained good motor function of the lower leg and foot, confirmed by EMG showing good activation in the leg muscles and some reinnervation in the foot muscles, as well as some sensory function of the sole of the foot. The other patient regained no motor (confirmed by EMG) or sensory function in the leg or foot. Factors most influential on outcome in two cases were type of injury, nerve gap length and particularly type of reconstruction. A difference in follow-up and rehabilitation likely also influence outcome. MRI did not show any differences in DRG size of injured side compared to the uninjured side. fMRI showed normal activation in the primary somatosensory cortex as a response to cutaneous stimulation of the normal foot. However, none of the two patients showed any activation in the primary somatosensory cortex following cutaneous stimulation of the injured foot. In decision making of nerve repair and reconstruction data from animal experiments can be translated to clinical practice and to predict outcome in patients, although such data should be interpreted with caution and linked to clinical experience. Rat models may be useful to identify and study factors that influence outcome after peripheral nerve repair and reconstruction; procedures that should be done correctly and with a competent team. However, some factors, such as cognitive capacity and coping, known to influence outcome following nerve repair, are difficult to study in animal models. Future research has to find and develop new paths and techniques to study changes in the central nervous system after nerve injury and develop strategies to utilize brain plasticity during the rehabilitation.