Joint use of chitosan-PGA nerve guidance conduits and bone marrow mesenchymal stem celts to repair 50mm long median nerve defect combined 80mm long uinar nerve defect in the human upper arm

摘要

Purpose: The repair of peripheral nerve defects over long-distance is a tough problem in the clinics.This case study was performed to observe the repair outcomes and safety after surgical repair of long-distance peripheral nerve defect in the upper arm by implantation of chitosan-PGA nerve guidance conduits combined bone marrow mesenchymal stem cells. Methods: A 29 year-old woman, who was injured with 50mm long median nerve defect and 80mm iong ulnar nerve defects combined the muscle and blood vessel disruption in the right upper arm, received an emergency surgery to repair the soft tissue and restore the blood vessel connection. The nerve defect were repaired by implantation of chitosan-PGA nerve guidance conduits joint MSCs in the 40th day after injury. After surgical repair, a series of functional assessments were carried out in different times. Motor function was evaluated by the recovery of the joint movement and strength which supplied by the injured nerves. Sensory recovery was assessed by two-point discrimination and touch test with Semmes-Weinstein monofilament. Autonomic function monitored by Laser Doppler perfusion imaging (LDPI) and ninhydrin test. We observed changes of nerve conduits and nerve regeneration in human body through MRI, ultrasonic and electrophysiological. Blood and urinary routine tests, serum biochemical examinations including the hepatic and renal function tests were taken to monitor the safety of the nerve graft after surgery. Results: Six months post-implantation, the sweat secretion and cutaneous blood perfusion of the right hand showed increase, indicated the recovery of autonomic function. The range of the wrist flexion and finger abduction, adduction increased indicated the recovery of the motor function. But the patient felt obviously numb of her right hand, the same as pre-implantation. MRI and ultrasonic showed nerve conduits partially absorbed and regeneration of nerve fibers. No anomalies in blood and urinary routine and serum biochemical examinations were detected. No complications were observed. Conclusions: The results indicate that as an alternative to nerve autografts, chitosan-PGA nerve guidance conduits combined MSCs could be a effective and safe choice for repairing extended nerve defects in human. Figure 1. General observation of the injured right upper arm of the patient.(A) The muscle, blood vessel and nerve disruption in the right upper arm. (B) Appearance of the right upper arm 6 months post implantation. (C) Intra-operative view of the 50mm-long median nerve defect. (D) Surgical repair of the median nerve and uinar nerve defects.(E)(F) The wrist joint can be moved from the hyperextended to 0 degree flexion, against gravity. (G) Finger abduction. (H) Finger adduction. (I) The nerve conduits and nerve regeneration in human body through ultrasonic 2 months post implantation. (J) The ulnar nerve repaired by chitosan-PGA nerve guidance conduits combined MSCs was observed through MRI 6 months post implantation. (K) The cutaneous blood perfusion of the right hand before surgical repair.(L) The cutaneous blood perfusion of the right hand showed increase 6 months post implantation. (M) The cutaneous blood perfusion of the normal side, Patient's left hand.