超声引导注射富血小板血浆修复坐骨神经挤压伤  

Ultrasound-guided platelet-rich plasma injection for repair of sciatic nerve crush injury

作　　者：朱亚琼 金壮[2,5] 汪靖 方杰 李超超 胡永强 田晓琦 张颖 宋青 王月香[2] 罗渝昆[2] Zhu Yaqiong;Jin Zhuang;Wang Jing;Fang Jie;Li Chaochao;Hu Yongqiang;Tian Xiaoqi;Zhang Ying;Song Qing;Wang Yuexiang;Luo Yukun(Medical College of Nankai University,Tianjin 300071,China;Department of Ultrasound,Chinese PLA General Hospital,Beijing 100853,China;Beijing Key Laboratory of Regenerative Medicine in Orthopedics,Chinese PLA General Hospital,Beijing 100853,China;Key Laboratory of Musculoskeletal Trauma&War Injuries,Chinese PLA General Hospital,Beijing 100853,China;General hospital of Northern Theater Command,Shenyang 110018,Liaoning Province,China)

机构地区：[1]南开大学医学院,天津市300071 [2]解放军总医院超声科,北京市100853 [3]骨科再生医学北京市重点实验室,北京市100853 [4]全军骨科战创伤重点实验室,北京市100853 [5]北部战区总医院,辽宁省沈阳市110018

出　　处：《中国组织工程研究》2020年第20期3196-3201,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81671684)，项目负责人：王月香;国家重点研发计划项目课题(2017YFA04702)，项目参与者：王月香~~

摘　　要：背景:富血小板血浆富含影响肌腱、韧带、肌肉和骨愈合的生长因子,在此基础上,研究人员逐渐认识到富血小板血浆激活后释放的分子可调节周围神经早期炎症、激活许旺细胞、促进巨噬细胞极化及阻止胶原纤维的增生,成为神经功能恢复的关键驱动力。目的:探讨超声引导富血小板血浆注射修复坐骨神经挤压伤的价值。方法:将28只新西兰大白兔(北京隆安动物繁殖中心提供)随机分为4组,每组7只:正常组暴露右侧坐骨神经后直接缝合;对照组建立右侧坐骨神经挤压损伤模型;单频次注射组建立右侧坐骨神经挤压损伤模型,术后24 h于超声引导下在损伤神经周围注射自体富血小板血浆;多频次注射组建立右侧坐骨神经挤压损伤模型,术后24 h于超声引导下在损伤神经周围注射自体富血小板血浆,此后第3,5周各注射1次。术后12周,进行再生神经的组织学、形态学评价及失神经支配肌肉的湿质量恢复与组织学检测。实验经解放军总医院实验动物管理委员会批准(2015-x10-02)。结果与结论:①与对照组比较,单频次与多频次注射组再生轴突NF-200、S100染色累积吸光度值明显升高(P均<0.05);多频次注射组二者累积吸光度值高于单频次注射组(P均<0.05),但仍低于正常组(P均<0.05);②与对照组比较,单频次与多频次注射组有髓神经纤维密度、有髓神经纤维直径及髓鞘厚度明显增加(P均<0.05);多频次注射组3指标多于单频次注射组(P均<0.05),但仍低于正常组(P均<0.05);③与对照组比较,单频次与多频次注射组肌肉湿质量、肌纤维横截面积增加(P均<0.05);多频次注射组两指标多于单频次注射组(P均<0.05),但仍少于正常组(P均<0.05);④结果表明,超声引导自体富血小板血浆多频次注射治疗坐骨神经挤压伤具有良好的效果。BACKGROUND:Platelet-rich plasma(PRP)contains growth factors that affect tendon,ligament,muscle and bone healing.On this basis,researchers gradually realize that such molecules released after PRP activation can regulate the early inflammation of peripheral nerve injury,activate Schwann cells,promote the polarization of macrophages,and actively prevent the hyperplasia of collagen fibers,thus becoming the key drivers of nerve function recovery.OBJECTIVE:To evaluate the value of ultrasound-guided PRP injection in the repair of sciatic nerve crush injury.METHODS:Twenty-eight healthy New Zealand white rabbits(provided by the Beijing Longan Experimental Animal Breeding Center)were randomly divided into normal group,control group,single PRP group and multiple PRPs group.In the normal group,the right sciatic nerve was exposed and then sutured directly.In the control group,a compression injury model of the right sciatic nerve was established.In the single PRP group,autologous PRP was injected around the injured nerve under ultrasound guidance at 24 hours after modeling.In the multiple PRPs group,autologous PRP was injected around the injured nerve under ultrasound guidance at 24 hours after modeling,and then the PRP injection was performed once at the 3rd and 5th weeks after modeling.Histological and morphological observation of regenerated nerves,wet weight recovery and histological manifestations of the denervated muscle were evaluated at 12 weeks after modeling.The study protocol was approved by the Administrative Committee of Experimental Animals in PLA General Hospital with the approval No.2015-x10-02.RESULTS AND CONCLUSION:The integral optical density values of NF-200 and S100 staining,myelinated nerve fiber density,myelinated nerve fiber diameter and myelin sheath thickness were significantly increased in the single PRP and multiple PRPs groups compared with the control group(all P<0.05),and the multiple PRPs group showed better outcomes than the single PRP group(all P<0.05),but was still inferior to the normal grou

关 键 词：富血小板血浆 超声 周围神经损伤 挤压伤 神经修复 神经再生 坐骨神经 

分 类 号：R459.9[医药卫生—治疗学] R456[医药卫生—临床医学]