本文選題：羊膜 + 生物膜　； 參考：《中國組織工程研究》2017年18期

【摘要】：背景:改善局部微環(huán)境及減少局部瘢痕有利于周圍神經(jīng)再生促進神經(jīng)功能恢復。目的:評價新鮮羊膜促進周圍神經(jīng)損傷后再生的效果。方法:選用成年SD大鼠60只,制備單側(cè)坐骨神經(jīng)急性損傷模型,隨機分為人羊膜組、生物膜組、空白對照組,每組20只,均在顯微鏡下行神經(jīng)吻接術(shù),吻接處給予人新鮮羊膜、生物膜包裹,空白對照組修復神經(jīng)后不做任何處理。術(shù)后2,4,8,12周行大體觀察、光鏡觀察、免疫組織化學檢測;術(shù)后4,8,12周行透射電鏡觀察、軸突成像分析、復合肌肉動作電位檢測、坐骨神經(jīng)功能指數(shù)測定。結(jié)果與結(jié)論:(1)大體觀察:術(shù)后2周羊膜、生物膜局部稍有吸收,4周大部吸收,8周完全吸收。人羊膜組、生物膜組神經(jīng)和周圍組織稍有粘連且粘連較疏松,活動度可。空白對照組神經(jīng)和周圍組織廣泛緊密粘連,鈍性不易分離,活動度差;(2)光鏡觀察:術(shù)后2,4,8,12周,人羊膜組、生物膜組神經(jīng)恢復情況明顯優(yōu)于空白對照組;(3)電鏡觀察:術(shù)后4周,3組神經(jīng)纖維再生均不明顯,板層結(jié)構(gòu)均不清晰。術(shù)后8,12周,與空白對照組比較,人羊膜組、生物膜組神經(jīng)纖維再生數(shù)量更多、髓鞘厚度厚、板層結(jié)構(gòu)更清晰、軸突直徑更大;(4)免疫組織化學檢測:人羊膜組、生物膜組中S-100蛋白表達及分布均優(yōu)于同時期空白對照組;(5)軸突圖像分析:人羊膜組、生物膜組神經(jīng)吻合口遠端有髓神經(jīng)纖維直徑、髓鞘厚度及橫截面有髓神經(jīng)纖維數(shù)目均優(yōu)于同時期空白對照組,差異有顯著性意義(P0.05);(6)神經(jīng)電生理檢測:與空白對照組比較,人羊膜組、生物膜組潛伏期短、波幅高及神經(jīng)傳導速度快,差異有顯著性意義(P0.05);(7)坐骨神經(jīng)功能指數(shù):人羊膜組、生物膜組坐骨神經(jīng)功能指數(shù)均明顯高于同時期空白對照組,差異有顯著性意義(P0.05);(8)結(jié)果表明,人羊膜作為一種生物材料修復周圍神經(jīng)損傷效果較好,可以減輕受損神經(jīng)與周圍組織的粘連和減少神經(jīng)吻合處的瘢痕形成,可促進神經(jīng)纖維再生、軸突直徑增大、髓鞘增厚,可以減輕神經(jīng)切口處炎性反應(yīng)、免疫反應(yīng)。
[Abstract]:Background: improving local microenvironment and reducing local scar are beneficial to peripheral nerve regeneration and nerve function recovery. Objective: to evaluate the effect of fresh amniotic membrane on regeneration after peripheral nerve injury. Methods: sixty adult SD rats were randomly divided into human amniotic membrane group, biofilm group and blank control group. Biofilm encapsulated, blank control group after nerve repair did not do any treatment. At 12 weeks after operation, gross observation, light microscope observation and immunohistochemical examination were performed, and transmission electron microscopy, axonal imaging, combined muscle action potential and sciatic nerve function index were observed 12 weeks after operation. Results and conclusion: at 2 weeks after operation, the biofilm was slightly absorbed and most of the biofilm absorbed completely at 8 weeks. In human amniotic membrane group and biofilm group, there was a slight adhesion between nerve and surrounding tissue, and the adhesion was looser. In the blank control group, the nerve and surrounding tissues were closely conglutinated widely, the blunt nature was not easy to be separated, and the activity was not easy to be separated. The observation under light microscope was as follows: 12 weeks after the operation, the human amniotic membrane group was treated with human amniotic membrane. The nerve recovery in the biofilm group was significantly better than that in the blank control group. The nerve fiber regeneration was not obvious and the lamellar structure was not clear 4 weeks after operation in the biofilm group. 812 weeks after operation, compared with the blank control group, the number of nerve fibers regenerated in the human amniotic membrane group and the biofilm group were more abundant, the thickness of myelin sheath was thicker, the lamellar structure was clearer, and the axon diameter was larger. The expression and distribution of S-100 protein in the biofilm group were superior to those in the control group (P < 0.05). The diameter of myelinated nerve fibers at the distal end of nerve anastomosis in human amniotic membrane group and biofilm group was higher than that in the control group. The thickness of myelin sheath and the number of myelinated nerve fibers in cross section were better than those in the control group at the same time, and the difference was significant (P 0.05). Compared with the blank control group, the incubation period of human amniotic membrane group and biofilm group was shorter than that of the blank control group. The sciatic nerve function index of human amniotic membrane group and biofilm group were significantly higher than that of the control group in the same period, and the difference was significant (P 0.05). As a biomaterial, human amniotic membrane can reduce the adhesion between the injured nerve and the surrounding tissues, reduce the scar formation in the nerve anastomosis, promote the regeneration of nerve fibers, increase the diameter of axons and increase the thickness of myelin sheath. It can reduce inflammatory reaction and immune reaction in the nerve incision.
【作者單位】： 河北醫(yī)科大學第三醫(yī)院;
【基金】：河北省自然科學基金(ZL20140066)~~
【分類號】：R318.08;R688

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