双侧腰4神经根吻合术修复中枢性下肢瘫痪的动物实验研究  

Animal experimental study on neurotization of bilateral fourth lumbar spinal nerve roots for repair of central paraplegia

作　　者：钱腾达 郑锡凤 张斌[1] 钱春生 张兴 何云文 陈传新 李益欢 潘佳恒 李立新[4] Qian Tengda;Zheng Xifeng;Zhang Bin;Qian Chunsheng;Zhang Xing;He Yunwen;Chen Chuanxin;Li Yihuan;Pan Jiaheng;Li Lixin(Department of Neurosurgery,Jintan Hospital,Shanghai General Hospital,Changzhou 213200,China;Department of Gastroenterology,Jintan Hospital,Shanghai General Hospital,Changzhou 213200,China;Department of Bone and Joint,Jintan Hospital,Shanghai General Hospital,Changzhou 213200,China;Department of Neurosurgery,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]上海市第一人民医院金坛医院神经外科,常州213200 [2]上海市第一人民医院金坛医院消化内科,常州213200 [3]上海市第一人民医院金坛医院骨科,常州213200 [4]南京医科大学附属第一医院神经外科,南京210029

出　　处：《中华神经外科杂志》2023年第11期1146-1153,共8页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81171147);常州市科技计划(CJ20210004,CJ20220003,CE20235001);江苏省“强卫医学重点人才”基金(ZDRCA2016010)。

摘　　要：目的探讨双侧腰4(L_(4))神经根吻合术对大鼠中枢性下肢瘫痪的修复效果及术后大脑皮质重塑的规律.方法采用自体股动脉血注入法制作中枢性右侧下肢瘫痪大鼠模型.采用肌电图和行为学测试评估动物模型.实验分为模型大鼠双侧L_(4)显露组、横断组、吻合组,健康大鼠双侧L_(4)横断组及健康大鼠组5组,每组12只.分别于术后1、9、13、17周对5组大鼠行神经行为学测试;对模型大鼠双侧L_(4)吻合组与健康大鼠组行神经电生理检测、逆行性示踪检测,并进行静息态和任务态功能性磁共振成像(fMRI)检查,对所得数据进行后处理及可视化重建.结果大鼠中枢性右侧下肢瘫痪模型的建模成功率为71.7%(43/60).术后双侧L_(4)吻合组模型大鼠右侧下肢(患侧)无明显伸、屈活动;术后17周,髋、膝、踝关节见伸、屈运动.重复测量的方差分析结果显示,5组大鼠间术后患肢Basso-Beattie Bresnahan运动评定量表评分(简称BBB评分)和滑脱率的差异均具有统计学意义(均P<0.05);术后1周,与健康大鼠双侧L_(4)横断组及健康大鼠组比较,模型大鼠双侧L_(4)显露组、横断组及吻合组患肢BBB评分较低、横杆测试滑脱率较高(均P<0.05);随着时间推移,双侧L_(4)吻合组的患肢BBB评分升高、横杆测试滑脱率下降(均P<0.05),且术后17周时患肢BBB评分与健康大鼠组的差异无统计学意义(P>0.05).神经传导检测中,随着时间推移,模型大鼠双侧L_(4)吻合组的复合肌肉动作电位潜伏期逐渐缩短,波幅逐渐增高(均P<0.05);术后17周,模型大鼠双侧L_(4)吻合组与健康大鼠组复合肌肉动作电位波幅和潜伏期的差异均无统计学意义(均P>0.05).逆行性示踪实验显示,术后9周,模型大鼠双侧L_(4)吻合组L_(4)-L_(4)再生神经根吻合口远端可见大量、广泛分布的金黄色荧光标记细胞,吻合口近端荧光分布稀疏;L_(4)节段脊髓切片中,左侧脊髓前角内聚集大量荧光金标�Objective To explore the effect of neurotization of bilateral fourth lumbar spinal nerve roots on hindlimb paralysis after central neurologic diseases in rats and the principle of postoperative cerebral cortical remodeling.Methods A model of the right leg paralysis after central neurological diseases was created by infusion of autologous arterial blood.Animal models were evaluated using electromyography and behavioral testing.The experiment was divided into 5 groups:bilateral L_(4) exposure group,transection group,and neurotization group of model rats,as well as bilateral L_(4) transection group of healthy rats and healthy rat group,with 12 rats in each group.Neurobehavioral tests were performed on five groups of rats at 1,9,13,and 17 weeks after surgery.Neuroelectrophysiological tests and retrograde tracing were performed on the model rat bilateral L_(4) neurotization group and the healthy rat group.Resting-state and task-state functional magnetic resonance(fMRI)scans were performed.Post-processing and visual reconstruction of the obtained data were conducted.Results The modeling success rate of the rat central right lower limb paralysis model was 71.7%(43/60).After surgery,the right lower limb(affected side)of the model rats in the bilateral L_(4) neurotization group had no obvious extension and flexion movements.At 17 weeks after surgery,the hip,knee,and ankle joints showed extension and flexion movements.The results of repeated measures analysis of variance showed that the differences in postoperative Basso-Beattie Bresnahan locomotor rating scale(BBB rating scale)scores and slippage rates in rod test among the five groups of rats were statistically significant(all P<0.05).One week after surgery,compared with the bilateral L_(4) transection group of healthy rats and the healthy rat group,the rats in bilateral L_(4) exposure group,transection group,and neurotization group of model rats had lower BBB scores of the affected limbs and higher rod test slippage rates(all P<0.05).Over time,the BBB score of the affec

关 键 词：偏瘫 神经移位 大脑皮质 功能恢复 大鼠 

分 类 号：R651.1[医药卫生—外科学]