Li Ying, Yamamoto Mie, Raisman Geoffrey, Choi David, Carlstedt Thomas
Institute of Neurology, University College London, and National Hospital for Neurology and Neurosurgery, London, England.
Neurosurgery. 2007 Apr;60(4):734-40; discussion 740-1. doi: 10.1227/01.NEU.0000255406.76645.EA.
A series of published cases show that repair of brachial plexus injuries by reimplantation of avulsed spinal roots can restore a degree of recovery, particularly to the more proximal shoulder and arm musculature in a proportion of patients. There remains, however, some disagreement regarding how far the benefits outweigh the risks of causing further spinal cord damage. Improving the number of motor fibers regenerating into the reimplanted ventral roots may enhance the muscular recovery, possibly extending it to the more useful distal musculature that would restore a degree of wrist and finger functions.
This study was based on our previous rat model showing regeneration of severed fibers and resumption of function after transplantation of cultured adult olfactory ensheathing cells into spinal cord injuries and reimplanted dorsal roots.
We now report that olfactory ensheathing cells transplanted at the spinal cord interface of reimplanted S1 ventral roots survive and migrate selectively into the ventral root where they associate intimately with regenerating ventral root fibers. Whereas only approximately 20% of the normal complement of fibers enter roots reimplanted without olfactory ensheathing cells, this increases to 80% in the presence of olfactory ensheathing cell transplants.
These observations suggest that transplants of olfactory ensheathing cells could improve the outcome of ventral root repair.
一系列已发表的病例表明，通过再植撕脱的脊神经根来修复臂丛神经损伤能够恢复一定程度的功能，特别是在部分患者中，对更靠近近端的肩部和手臂肌肉组织的恢复效果尤为明显。然而，对于益处是否超过造成进一步脊髓损伤的风险，仍存在一些争议。增加再生进入再植腹侧神经根的运动纤维数量可能会增强肌肉恢复效果，甚至有可能将恢复范围扩展到更具实用价值的远端肌肉组织，从而恢复一定程度的腕部和手指功能。
本研究基于我们之前的大鼠模型，该模型显示将培养的成年嗅鞘细胞移植到脊髓损伤处并再植背根后，切断的纤维能够再生且功能得以恢复。
我们现在报告，在再植的S1腹侧神经根的脊髓界面处移植的嗅鞘细胞能够存活，并选择性地迁移到腹侧神经根中，在那里它们与再生的腹侧根纤维紧密相连。在没有嗅鞘细胞移植的情况下，再植的神经根中只有约20%的正常纤维数量能够进入；而在有嗅鞘细胞移植的情况下，这一比例增加到了80%。
这些观察结果表明，嗅鞘细胞移植可以改善腹侧根修复的效果。
