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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2016, Vol. 02 ›› Issue (01) : 5 -8. doi: 10.3877/cma.j.issn.2095-9141.2016.01.002

所属专题： 文献；

临床研究

自体骨髓间充质干细胞移植治疗颅脑损伤后痉挛性瘫痪
伊西才1, 魏礼洲1, 黑悦1, 龙乾发2, 王博晨1, 田沁涛1, 周跃飞1, 刘卫平1,†()   
  1. 1. 710032　西安，第四军医大学西京医院神经外科
    2. 710003　西安，西安市中心医院神经外科
  • 收稿日期:2015-12-20 出版日期:2016-02-15
  • 通信作者: 刘卫平
  • 基金资助:
    陕西省科技统筹基金资助项目(2013KTCL03-08)

Spastic paralysis after traumatic brain injury treated by autologous bone marrow mesenchymal stem cells

Xicai Yi1, Lizhou Wei1, Yue Hei1, Qianfa Long2, Bochen Wang1, Qintao Tian1, Yuefei Zhou1, Weiping Liu1,†()   

  1. 1. Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi′an 710032, China
    2. Department of Neurosurgery, Xi′an Central Hospital, Xi′an 710003, China
  • Received:2015-12-20 Published:2016-02-15
  • Corresponding author: Weiping Liu
  • About author:
    Corresponding author: Liu Weiping, Email:
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伊西才, 魏礼洲, 黑悦, 龙乾发, 王博晨, 田沁涛, 周跃飞, 刘卫平. 自体骨髓间充质干细胞移植治疗颅脑损伤后痉挛性瘫痪[J]. 中华神经创伤外科电子杂志, 2016, 02(01): 5-8.

Xicai Yi, Lizhou Wei, Yue Hei, Qianfa Long, Bochen Wang, Qintao Tian, Yuefei Zhou, Weiping Liu. Spastic paralysis after traumatic brain injury treated by autologous bone marrow mesenchymal stem cells[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(01): 5-8.

目的

探讨应用自体骨髓间充质干细胞治疗颅脑损伤后痉挛性瘫痪的临床疗效。

方法

回顾性分析第四军医大学西京医院神经外科自2009年5月至2014年4月治疗的33例颅脑损伤后痉挛性瘫痪患者，完成4次自体骨髓间充质干细胞移植，每周1次，每次经腰椎穿刺蛛网膜下腔注射，细胞数为2×107，移植前、移植后1个月、3个月、6个月通过改良Ashworth分级、Brunnstrom分级评估患侧上下肢肌张力、运动功能，并行脑PET/CT、脑电图、偏瘫肢体肌电图检查。

结果

移植后1个月开始Brunnstrom分级较移植前改善。移植后3个月开始Ashworth分级较移植前改善。5例移植后3个月头颅PET/CT见脑葡萄糖代谢减低较前改善。临床观察未发现明显不良反应，脑电图、偏瘫肢体肌电图检查未见明显变化。

结论

自体骨髓间充质干细胞移植对颅脑损伤后痉挛性瘫痪的肢体肌张力增高和运动障碍均有改善，移植后6个月内通过临床观察及影像学检查未发现不良反应，为临床治疗颅脑损伤后遗症提供了新方法。

关键词: 颅脑损伤, 骨髓间充质干细胞, 痉挛性瘫痪, 肌张力
Objective

To investigate the clinical efficacy of autologous bone marrow mesenchymal stem cells transplantation on spastic paralysis after traumatic brain injury.

Methods

During May 2009 to April 2014, the clinical data about 33 patients with spastic paralysis after traumatic brain injury were retrospectively analyzed. Bone marrow puncture was performed under general anesthesia. Bone marrow mesenchymal stem cells (2×107) were intrathecally transplanted once a week for four weeks. The measurement points contain before treatment, one month, three months and six months after treatment. Muscular tension and movement disorders were evaluated using modified Ashworth scale and Brunnstrom stage classification respectively. Besides that, brain PET/CT, electroencephalo-graphy and electromyography were recorded.

Results

Muscular tone was improved one month after treatment . Movement disorders were improved 3 months after treatment. PET/CT revealed the glucose metabolism defect was ameliorated in 5 cases 3 months after transplantation. No apparent change was found on the electroencephalography or electromyography after transplantation.

Conclusion

The clinical efficacy of autologous bone marrow mesenchymal stem cells on spastic paralysis after traumatic brain injury was detected by modified Ashworth scale and Brunnstrom stage classification after treatment. No any adverse reactions in the treatment were found by clinical observation and imageological examination.

Key words: Brain injuries, Bone marrow mesenchymal stem cells, Spastic paralysis, Muscle tone
表1 自体骨髓间充质干细胞移植前后肢体Ashworth分级的比较(n)
部位 Ashworth分级 0个月 1个月 3个月 6个月
上肢 0级 0 0 4 5
? 1/1+级 2 4 6 8
? 2级 22 22 18 16
? 3级 7 6 4 3
? 4级 2 1 1 1
? ? ? P>0.05 P<0.001 P<0.01
下肢 0级 0 1 5 5
? 1/1+级 3 4 7 8
? 2级 21 21 17 16
? 3级 8 6 3 3
? 4级 1 1 1 1
? ? ? P>0.05 P<0.001 P<0.01
表2 自体骨髓间充质干细胞移植前后肢体Brunnstrom评分的比较(n)
部位 Brunnstrom评分 0个月 1个月 3个月 6个月
上肢 1 0 0 0 0
? 2 3 2 1 1
? 3 22 21 15 14
? 4 8 9 14 13
? 5 0 1 2 3
? 6 0 0 1 2
? ? ? P<0.01 P<0.01 P<0.01
下肢 1 1 1 0 0
? 2 3 2 1 1
? 3 21 18 15 10
? 4 8 11 13 16
? 5 0 1 3 4
? 6 0 0 1 2
? ? ? P<0.05 P<0.01 P<0.01
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