去细胞同种异体神经移植修复周围神经缺损临床安全性研究  

Clinical safety about repairing the peripheral nerve defects with chemically extracted acellular nerve allograft

作　　者：杨润功[1] 衷鸿宾[1] 朱加亮[1] 左坦坦[1] 吴克俭[1] 侯树勋[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中华外科杂志》2012年第1期74-76,共3页Chinese Journal of Surgery

摘　　要：目的探讨化学去细胞同种异体神经移植修复人体周围神经缺损的临床安全性。方法从2002年3月至2011年1月，取成年遗体捐献者的周围神经，使用化学萃取法制备去细胞同种异体神经，将其消毒、储存，并用于临床治疗41例周围神经缺损患者。男性38例，女性3例，年龄10—55岁。受伤至神经修复时间10h至9个月，平均4．1个月。受损神经包括臂丛神经10例，上臂桡神经3例，前臂尺神经4例，指（趾）神经12例，坐骨神经2例，胫神经3例，腓总神经5例，股神经2例。合并骨折12例，合并软组织损伤或缺损20例。神经桥接长度2～10em，平均6．1cm。术后不使用免疫抑制药物。术后随访9～51个月，平均20．2个月。通过手术部位物理检查及血生化和免疫检测以评价移植的安全性。结果术后患者全部得到随访，39例伤口一期愈合，2例发生表浅感染，经换药后延迟愈合。所有患者均未发生免疫排斥反应、过敏性反应、深部感染、肝肾毒副作用等不良反应。术后1、12周血生化检测均正常，特种蛋白、淋巴细胞亚群等免疫检测指标术前、术后差异无统计学意义。结论临床上采用去细胞同种异体神经移植修复人体周围神经缺损是安全的。Objective To discuss the clinical safety about repairing the peripheral nerve defects with the acellular allogeneic nerve. Methods The 41 patients （male 38, female 3, age 10-55 years old, average 28.9 years old ） who were performed chemically extracted acellular nerve allograft transplanting to repair nerve defects from 2002 to 2011. The average interval from injury to nerve repairing was 4. 1 months （range, 10 hours to 9 months）. There were 41 cases nerve defects including 10 hrachial plexus nerves, 3 radial nerves of upper arm, 4 ulnar nerves of forearm, 12 digital and toe nerves, 2 sciatic nerves, 2 femoral nerves, 3 tibial nerves and 5 common peroneal nerves. There were 12 cases combinated fractures and 20 soft tissue injury or defects. The average length of the nerve allograft to bridge the nerve defects was 6. 1 cm （range, 2-10 cm）. No immunosuppressive drugs were used in all cases. The clinical safety was evaluated through physical examination, blood biochemistry and immunity detection. Results All cases were followed up post-operation. They got primary wound healing except 2 superficial infection who got delay healing through dressings changing. No any adverse effects happened including immunological rejection, hypersensitivity reaction, deep infection, hepatotoxicity and ephrotoxicity. Conclusions It is safe and feasible to repairing human peripheral nerve defects with chemically extracted acellular nerve allograft.

关 键 词：去细胞神经 移植 同种 周围神经 

分 类 号：R651.3[医药卫生—外科学]