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背景:动物实验研究已证实,采用细胞移植、神经营养因子注入或移植等方法可改变损伤脊髓局部环境,促使损伤脊髓恢复部分功能。目的:开展嗅鞘细胞移植治疗脊髓炎后遗症的临床实验,观察其对脊髓损伤的恢复作用。设计:非随机自身对照。单位:山东省泰安荣军医院外二科病房。对象:选择2004-06/2007-07来源于全国各地的陈旧性脊髓炎患者32例,伤后时间为0.5～7年。患者经各种传统治疗及肢体功能锻炼后神经功能无明显改善,并遗留各种感觉运动及植物神经功能障碍。男21例,女11例,年龄5～48岁,急性病毒性脊髓炎18例,急性化脓性脊髓炎8例,结核性脊髓炎6例,发病后均曾给予大剂量甲基强地松龙、地塞米松、抗炎、抗免疫及各种神经营养药物治疗。26例临床表现均为完全性损伤。6例为不完全性损伤,患者对治疗知情同意,治疗方案经过医院伦理委员会批准。胚胎嗅球来自流产胚胎,由患者或家属自愿捐献。方法:取胚胎嗅球,经细胞分离、培养、纯化7～14 d,最后消化成单细胞混悬液,然后在手术显微镜下移植到患者损伤脊髓区域的上下方。术后2周～2个月,采用2000年美国脊髓损伤学会制定的ASIA评分标准进行术后评定,并进行手术前后对比。主要观察指标:①感觉功能变化。②运动功能变化。结果:嗅鞘细胞移植术后0.5-2年,32例患者感觉和运动功能均有明显改善(运动功能:51.53±13.41,55.72±10.50;轻触觉:63.06±15.98,69.53±11.68;疼痛觉:64.03±15.01,69.50±12.20,P均<0.01)。结论:嗅鞘细胞移植能够有助于脊髓炎后遗症患者的神经功能恢复,但长期疗效有待于进一步观察。
BACKGROUND: Animal experimental studies have confirmed that the use of cell transplantation, neurotrophic factor injection or transplantation and other methods can change the local environment of the injured spinal cord to promote damage to the spinal cord recovery part of the function. OBJECTIVE: To carry out the clinical experiment of olfactory ensheathing cell transplantation for the treatment of sequelae of myelitis and to observe its effect on the recovery of spinal cord injury. Design: Non-random self-control. Unit: Shandong Inland Rongjun Hospital Ward two. PARTICIPANTS: Thirty-two patients with old myelitis from 2004-06 / 2007-07 were selected. The duration of injury was 0.5-7 years. Patients with various traditional treatment and physical function after exercise did not significantly improve neurological function, and left a variety of sensory motor and autonomic dysfunction. 21 males and 11 females, aged 5 to 48 years, 18 cases of acute viral myelitis, acute suppurative myelitis in 8 cases, 6 cases of tuberculous myelitis, have been given high doses of methylprednisolone , Dexamethasone, anti-inflammatory, anti-immune and various neurotrophic drugs. 26 cases of clinical manifestations were complete injury. 6 cases of incomplete injury, informed consent for treatment, the treatment plan approved by the hospital ethics committee. The olfactory bulb of the embryo is from a miscarried embryo and is volunteered by the patient or family member. Methods: The embryonic olfactory bulb was isolated, cultured and purified for 7-14 days. The cells were finally digested into single-cell suspension and then transplanted to the upper and lower parts of the injured spinal cord area under the operating microscope. Two weeks to two months after surgery, the American Society of Spinal Cord Injury (ASIA) criteria established in 2000 were used for postoperative evaluation and were compared before and after surgery. MAIN OUTCOME MEASURES: ① Sensory function changes. ② changes in motor function. Results: Sensory and motor functions were significantly improved in 32 patients (motor function: 51.53 ± 13.41,55.72 ± 10.50; tactile sensation: 63.06 ± 15.98 and 69.53 ± 11.68, respectively) at 0.5-2 years after transplantation of olfactory ensheathing cells. Pain sensation: 64.03 ± 15.01,69.50 ± 12.20, P <0.01). Conclusion: Olfactory ensheathing cell transplantation can contribute to the recovery of neurological function in patients with myelitis sequelae, but the long-term effect needs further observation.