嗅鞘细胞髓内移植修复完全性晚期脊髓损伤手术多中心比较  

Multi-Center Comparison of Olfactory Ensheathing Cell Intramedullary Transplantation for Treatment of Complete Chronic Spinal Cord Injury

作　　者：陈琳[1] 贺西京[2] 黄红云[3] 萧凯[1] 崔志强[1] 张玉琪[1] CHEN Lin;HE Xi-jing;HUANG Hong-yun;XIAO Kai;CUI Zhi-qiang;ZHANG Yu-qi(Department of Neurosurgery and Department of Neurorestoratology,Yuquan Hospital,Tsinghua University,Beijing 100040,China;Department of Orthopaedics,Second Affiliated Hospital of Xi'an Jiaotong University,Xian 710004,China;Institute of Neurorestoratology,Third Medical Center,General Hospital of PLA,Beijing 100039,China)

机构地区：[1]清华大学玉泉医院神经外科中心神经修复科,北京100040 [2]西安交通大学第二附属医院骨科,西安710004 [3]解放军总医院第三医学中心神经修复学研究所,北京100039

出　　处：《神经损伤与功能重建》2020年第2期103-107,共5页Neural Injury and Functional Reconstruction

摘　　要：目的:比较嗅鞘细胞(OECs)髓内移植修复脊髓损伤(SCI)手术多个临床中心结果,探讨适合临床要求的标准化移植手术。方法:汇总有代表性的临床治疗中心的研究结果,分析其移植细胞浓度、细胞总量、切口选择、移植部位、移植点数目、移植器械的优缺点、术后管理等方面,对比这些不同的参数对临床结果的可能影响。结果:共纳入4项临床研究,均是采用脊髓髓内实质内移植手术方式治疗晚期完全性SCI,包含中国中心2个,澳大利亚中心1个,欧洲中心1个,进行对比。细胞植入脊髓实质对晚期完全性SCI的功能恢复有一定效果。符合临床实际的简洁手术可能比精准的复杂操作手术更有优势。单位体积内过大移植容量,过长手术时间、过多细胞移植穿刺注射点可能是导致手术效果不佳的重要原因,移植术后需要足够的康复训练。结论:细胞植入脊髓实质对晚期完全性SCI患者神经功能恢复有效;简洁的手术可能比精准复杂注射操作更适合临床,但不适当的操作程序会导致无效的结果;移植术后需要足够的康复训练。Objective:To compare the results of intramedullary transplantation of olfactory ensheathing cells(OECs)in the repair of spinal cord injury(SCI)in patients at multiple clinical centers,and to explore the standardized transplantation procedures that suit clinical needs.Methods:The results of representative clinical centers were collected and analyzed.Parameters including the concentration of cells,total number of cells,choice of incision,site of transplantation,number of transplantation sites,advantages and disadvantages of transplantation equipment,and postoperative management were compared to clarify impact on clinical outcomes.Results:Four clinical cases were compared in this study:two Chinese centers,one Australian center,and one European center;all cases employed intraspinal intramedullary intraspinal transplantation for the treatment of chronic complete SCI.Cell implantation into the spinal cord parenchyma had certain effect on recovery in chronic complete SCI.Concise surgery appeared to be more suitable for clinical application than precise and complex injection procedures.An excessively large total volume of injection,long procedure time,and large number of cell transplant injection points are possible reasons for suboptimal results of surgery.Sufficient rehabilitation training after transplantation is necessary.Conclusion:Cell implantation into the spinal cord parenchyma is effective for recovery of neurological function in chronic complete SCI patients.Concise surgery appears to be more suitable for clinical application than precise and complex injection procedures,but improper procedures may lead to ineffective results.Sufficient rehabilitation training post-surgery is necessary for the integration of motor recovery.

关 键 词：嗅鞘细胞 脊髓内移植 神经修复 完全性晚期脊髓损伤 手术 多中心比较 

分 类 号：R741[医药卫生—神经病学与精神病学] R605[医药卫生—临床医学]