中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (10): 1540-1544.doi: 10.4103/1673-5374.167747

• 综述:周围神经损伤修复保护与再生 • 上一篇    下一篇

迟发性周围神经修复:“保护”萎缩雪旺细胞促进神经再生的手术方法

  

  • 收稿日期:2015-09-10 出版日期:2015-10-28 发布日期:2015-10-28

Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration

Tessa Gordon*, Placheta Eva, Gregory H. Borschel   

  1. Department of Surgery, Division of Plastic Reconstructive Surgery, the Hospital for Sick Children, Toronto, Canada
  • Received:2015-09-10 Online:2015-10-28 Published:2015-10-28
  • Contact: Tessa Gordon, Ph.D.,tessat.gordon@gmail.com.

摘要:

迟发性周围神经修复:“保护”萎缩雪旺细胞促进神经再生的手术方法
运动神经细胞纤维受伤后,与细胞本体部分距离较远的断端神经纤维会逐渐死亡退化,受损的神经组织被巨噬细胞清除,因此原本由运动神经控制的肌细胞也渐渐出现萎缩。损伤的神经轴通过芽生穿过许旺细胞构建的通道到达目标器官或组织。神经生长速度约为1mm/天,如果缺乏许旺细胞与神经轴的连接,神经轴就会死亡,神经修复也不会发生。作者最新研究表明,通过简短电刺激横断神经的近端神经断端,可以有效的加速横断病变部位轴突的生长,加速失神经靶点的神经支配,甚至可刺激延迟后神经修复。在文章中,作者详细介绍了是如何应用电刺激结合手术技巧“保护”慢性失神经支配雪旺氏细胞,并促进神经再生改善神经修复功能结局的方法。

Abstract:

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating
axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated
muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges) into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated
in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ‘protect’ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

Key words: peripheral nerve injury, nerve repair, nerve regeneration, Schwann cells, electrical nerve stimulation, axon regeneration