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Development of new therapy for causalgie using in situ Tissue Engineering.

利用原位组织工程开发新的因果疗法。

基本信息

批准号：
17390426
负责人：
INADA Yuji
金额：
$ 9.66万
依托单位：
Kyoto University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2005
资助国家：
日本
起止时间：
2005 至 2006
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-17390426/
关键词：
pain CRPS causalgia collagen nerve guide nerve tube regeneration peripheral nerve

项目摘要

As the results of this project, we have already applied the new theory to clinics and reported two clinical cases of chronic pain. Though causalgia is often the result of partial injury to a major nerve, most commonly the median nerve supplying the hand, it is also seen following the digital nerve injury. The preoperative symptoms had become stable and they had been diagnosed by pain clinicians as having CRPS type II accompanied by allodynia, tremor, joint contracture, and vasomotor abnormality. At surgery, nerve sprouting was observed to extend from the proximal and distal sites of the injured nerve to the surrounding tissues. In these two cases, sprouting had also occurred in the distal part of the injured nerve and spread to the areas in which pain was observed. Surgery in the present two cases involved insertion of the nerve stumps into a PGA-collagen tube, thus covering the nerve ends. Hollow PGA resorbable nerve tubes have already been used clinically. Removing the neuroma with associated nerve sprouts and covering the nerve ends with a PGA tube might reduce the pain. Both of our present patients showed functional recovery, as indicated by electrophysiological evaluations, after successful nerve regeneration. Accordingly, peripheral nerve recovery may have an influence on central nerve function to prevent the recurrence of causalgia. Further clinical studies will be necessary to determine whether the tube is also effective for other clinical symptoms of causalgia, such as mirror region, phantom pain. Thus, the clinical outcomes in these cases indicate the possibility of a new surgical approach using a nerve guide tube for resolution of peripheral nerve injury accompanied by causalgia and functional loss.

作为本项目的成果，我们已经将这一新理论应用于临床，并报道了两例慢性疼痛的临床病例。虽然头痛通常是主要神经部分损伤的结果，最常见的是供应手的正中神经，但也可以在指神经损伤后看到。术前症状已稳定，疼痛临床医生诊断为CRPS II型伴异常性疼痛、震颤、关节挛缩和血管扩张异常。在手术中，观察到神经发芽从损伤神经的近端和远端部位延伸到周围组织。在这两个病例中，在受损神经的远端部分也发生了发芽，并扩散到观察到疼痛的区域。在目前的两个案例中，手术涉及将神经残端插入PGA胶原管中，从而覆盖神经末端。中空PGA可吸收神经管已应用于临床。切除神经瘤和相关的神经芽，并用PGA管覆盖神经末端可能会减轻疼痛。我们目前的病人都表现出功能恢复，如电生理评估所示，成功的神经再生后。因此，周围神经恢复可能对中枢神经功能产生影响，以防止头痛复发。进一步的临床研究将是必要的，以确定该管是否也是有效的其他临床症状的头痛，如镜像区，幻痛。因此，这些病例的临床结局表明，使用神经导管的新手术方法可能用于解决伴有头痛和功能丧失的周围神经损伤。