| Since the middle of twentieth century, with the development of mechanical industry, transportation, construction and the automotive industry, high-tech brings high convenience to life. At the same time, the number of high-energy trauma cases is rising. The pelvis is an important bony structure of body, it is not only important for connecting the upper part of the body and legs, what is more, it is an important protective structures for pelvic organs. In these high energy injury cases, spinal and pelvic fracture increased significantly. Particularly, unstable spinal and pelvic fractures, especially in the case of multiple high energy traumas, the incidence remains high. So the treatment has become the focus. At present, with the development of materials engineering and mechanical engineering of the human body, the treatment technology of bone fracture have been developing rapidly. However, due to the special nature of structure on the peripheral nervous system, the nervous system damage will inevitably when this type of injury occurs, and the treatment is difficult. Pelvic fractures, especially sacral fracture in patient, very easily lead to excessive traction of the sacral plexus, avulsion, complete rupture, and so on. Pelvic fracture and lumbosacral plexus injury caused multiple nerves at the same time, when pelvic fracture and lumbosacral plexus injury, neurological complications will occur. Pelvic fracture and lumbosacral plexus injury have been a medical problem for a long time, but the surgical treatment is very limited, and the efficacy is not satisfactory. So how to treat the fracture of pelvic and lumbosacral plexus injury has been plagued by orthopaedic surgeons and neurological kinesiotherapist. Therefore, how to found new methods to treat this type of injury is a great challenge. For the treatment of sacral plexus injuries, looking for new power nerve to recovery the lower limb function. Our group using the rats as experimentation, compared with effect of the L 2 nerve and L 3 nerve as power nerve to reconstruct the injured nerves, looking for new treatment methods for the nerves injury.Part1Objective:Study on the feasibility of L2 and L3 nerve as a power nerve in rats.Methods:(1) Choose 20 adult SD rats, after exposed the L2 and L3 nerve root, to record the muscle dominated by L2 and L3 nerve. (2) Choose 20 adult SD rats, exposed the L1-L4 nerve root from intervertebral foramen, and using electromyography recorder to record the stimulation results on muscle. (3) Choose 40 adult SD rats, exposed and cut off the L2 and L3 nerve root, then record general condition on rats, detect the muscle functionl6 weeks postoperatively.Results:through the anatomical observation, The L2 nerve involved in cutaneous nerve, reproductive nerve and part of the femoral nerve, the L3 and L4 nerve innervation in femoral nerve; L2-L4 nerve participate part of the quadriceps.16 weeks postoperatively, the BBB score of rats were not obvious difference; there were no foot ulcer in rats. Pathology examination showed the muscle atrophy does not present obvious compared with the contralateral muscular.Conclusion:through anatomic measurement and electromyography testing in rats, the L2 and L3 nerve can be used as the power nerve safely.Part 2Objective:to evaluate the function of the lower limb after reconstruct sacral plexus injury in rats.Methods:(1)choose 90 adult SD rats by the method of not open the vertebral plate, exposed the L4-L6 nerve roots, use the microsurgery clasps cut off the L4-L6 nerve roots, the sacral plexus avulsion injury model was established. (2) After the sacral plexus avulsion injury model was established successful, rats were randomly divided into three groups:L2-L5 group, L3-L5 group and control group,16 weeks after surgery to observe the general condition, the muscle atrophy and nerve anastomosis in rats.Results:16 weeks postoperatively, the BBB score in anastomosis group was higher than the control group, the muscle atrophy in anastomosis group was better than the control group, the differences are statistically significant. The nerve fibers pass through the anastomosis of nerves.Conclusion:the L2 and L3 nerve can be used as the power nevre for reconstruct the plexus avulsion injury.Part 3Objective:evaluate the function of the peripheral nerve recovery after the L2 and L3 nerve as a power nevre reconstruct sacral plexus injury.Methods:choose 90 adult SD rats, and sacral plexus avulsion injury model was established. The rats were randomly divided into three groups:L2-L5 group, L3-L5 group and control group,16 weeks postoperatively, using immunohistochemical method to detect spinal motoneurons, useing the TRUE BLUE and fluorogold retrograde fluorescent tracer method detecting the pathways on spinal nerve.Results:the number of spinal motoneurons in anastomosis group is significantly higher than the control group, the difference is statistically significant. The neural pathway was effective.Conclusion:the spinal motoneurons nerve has certain protective effect after anastomosis.Part 4Objective:using the animal PET-CT brain imaging methods, research on the brain nerve recovery after the L2 or L3 nerve as a power nerve reconstruct sacral plexus injury.Methods:choose 80 adult SD rats, sacral plexus avulsion injury model was established. Rats were randomly divided into four groups:sacral plexus injury group, L2-L5 group, L3-L5 group and control group,6 months postoperatively, the rats fasting for 12 hours, from the tail vein inject 0.2 ml18F-FDG, use the electrical stimulation on the injured side limb about 30 minutes. Application of animal CT scan of rats scanning the brain, then record the graphics and data.Results:the avulsed group rats had no obvious imaging, anastomosis group rats show imaging partly, the control group of rats imaging obviously.Conclusion:after the nerve anastomosis, the brain of injured side in corresponding functional areas have active brain metabolic changes, shows brain neural pathways to obtain a certain degree of recovery. |
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