摘要
目的:探讨自体骨髓干细胞移植对下肢神经病变患者的治疗效果。方法:对2003-10/2004-07首都医科大学宣武医院血管外科收治的3例自体骨髓干细胞移植治疗下肢神经病变的临床资料进行回顾性分析。①病例1:因糖尿病10年,左下肢麻木及轻度疼痛入院,诊断为左下肢糖尿病足件末梢神经炎,行左下肢局部肌肉自体骨髓干细胞移植。②病例2:因糖尿病15年伴右下肢感觉消失入院,诊断为右下肢糖尿病足伴末梢神经炎,行右下肢局部肌肉自体骨髓干细胞移植。③病例3:因风湿性心脏病心房纤颤10年,突发性右下肢疼痛2d,在当地医院取栓术后再次形成血栓,至本院行尿激酶溶栓后下肢动脉血流恢复,但伴随出现右下肢腓总神经损伤和足下垂,且足趾剧烈疼痛。诊断为右下肢缺血性神经痛,行自体骨髓干细胞移植,同时进行肌肉局部移植术和动脉腔内移植术。结果:①病例1:自体骨髓干细胞移植后5d,疼痛基本缓解,2周后麻木明显减轻,3个月后麻木消失,肌电图显示下肢腓总神经和胫后神经传导速度减慢,但较术前明显增快。随访15个月无复发。②病例2:于2005-01-25肌电图检查显示,右下肢腓总神经和胫后神经传导速度均为36m/s。2005-01-28在硬膜外麻醉下,行右下肢局部肌肉自体骨髓干细胞移植。移植后5d疼痛基本缓解,2周后麻木明显减轻,1个月后下肢麻木消失,足部麻木明显减轻。2005-04-06肌电图显示右下肢腓总神经和胫后神经传导速度均减慢至34m/s,但较术前有所增快。2005-04-19在局部麻醉和硬膜外麻醉下,先后行经导管右下肢动脉腔内自体骨健干细胞移植和右下肢缺血局部肌肉自体骨髓干细胞移植。术后1周足部麻木明显减轻,术后10d足部麻木消失。③病例3:于2004-07-17肌电图检查显示,右胫神经(腘-腓肠肌内侧头)运动末端潜伏期为3.6ms,运动传导电位波幅为5.1mV;右胫神经(腘-拇展肌)、腓总神经、腓肠神经感觉运动传导电位消失、伴有足趾剧烈疼痛。2004-07-18在硬膜外麻醉下行自体骨髓干细胞移植。术后当晚足趾疼痛减轻,睡眠好;1周后右足有想活动的感觉;术后1个月疼痛消失,足趾可轻微活动;术后3个月足趾的活动力量可达3级;术后6个月可下床活动,有跛行,但可行走。2005-03-16肌电图显示:右胫神经(腘-腓肠肌内侧头)运动末端潜伏期缩短至28ms,运动传导电位波幅增高至7.4mv;右腓总神经(腓骨小头下-胫前肌)可见运动传导电位,但波幅显著降低为0.13mV;右胫神经(内踝-拇展肌)、右腓总神经(外踝上-伸趾短肌)运动电位消失;右胫神经、腓肠神经感觉传导电位仍然消失。患者可以自行行走,目前已经基本恢复正常生活。结论:在目前尚未寻找到更有效的办法来解决下肢神经病变的情况下,自体骨髓干细胞移植无疑是治疗方法中可行的一种,值得进一步开展临床观察和验证。
AIM: To investigate the effect of autologous bune marrow stem cell transplantation(BMSCT) on lower-extremity neuropathy. METHODS: A retrospective analysis was made in clinical data of 3 palients suffering from lower-extremity neuropathy who received au tologous BMSCT in the Department of Vascular Surgery. Xuanwu Hospital. Capital University of Medical Sciences between October 2003 and July 2004. (1) Patient 1 (female): She complatined of numbness and mild pain in her left lower limb due to a 10-year his-tory of diabetes mellitus, and she had been diagnosed as left diabetic fool accompanied by distal neuritis. Autologous bone marrow stem cells were injected intramuscularly into the local affected fower limb. (2) Patient 2(male): He was diagnosed as having right diabetic fool with distal neuritis after hospitalization due to anaesthesia in his right lower limb with 15-year diabetes mellitus.Autologous BMSCT was performed'in his right lower limb in the same way as in the patient 1. (3) Patient 3(female): She. who had been with ventricular fibrillation in her rheumatic heart for 10 years and sudden pain in her right lower limb for 2 days, was examined with secondary thrombus alter em bolectomy in a local hospital. Then, her arterial blood flow of lower extremity recovered to normal after urokinase thrombolysis in our hospital, but she was also accompanied by common peroneal nerve injury and fool drop in her right lower extremity as well as severe toe pain. Having been diagnosed as having ischemic neuralgia, she received autologous BMSCT by two approaches: local intramuscular injection and arterial intraluminal injection. RESULTS: (1)For patient 1: After autologous BMSCT, the pain was relieved nearly at 5 days; the numbness was greatly relieved at 2 weeks, and completely relieved after 3 months. In the electromyogram (EMC) examination, it was shown that the conduction velocity of common peroneal nerve and post-tibial nerve was decelerated in her left lower extremity, which was still faster than that before transplantation. No recurrent symptoms were found after 15-month follow-up. (2)For patient 2: Shown by EMC examination on January 25. 2005. the conduction velocity of common peroneal nerve and post-tibial nerve was 36 meters per second. He received local intramuscular injection of stem fells in right lower extremity under epidural anesthesia on January 28, 2005. After transplantation, the pain was greatly relieved at 5 days; the numbness was remarkably relieved at 2 weeks. and disappeared in his right lower limb and was relieved obviously in his right fool at 1 month. Shown by EMC examination on April 06, 2005. the conduction velocity of common peroneal nerve and post-tibial nerve was 34 meters per second, which was faster than that before operation to some extent. On April 19. 2005. autogolous stem cells were sequenlially injected into arterial lumens and into local ia chemic muscles both in his right lower extremity through catheters under local and epidural anesthesia. The foot numbness was remarkably relieved at 1 week and disappeared at 10 days after operation, (1) For patient 3: As shown by EMG examination on July 57, 2004, the latent period of the motor end of her right tibial nerve(the medial head of popliteal-sural muscle) was 3. 6 ms, and the amplitude of motor conduction potential was 5. 1 mV. Sensorimotor conduction potential disappeared in her right tibial nsrre(between popliteal fossa and hal-lucis abductor), common peroneal nerve and sural nerve accompanied by severe toe pain. Autologous BMSCT was performed under epidural anesthesia on July 18, 2004. On the right night of operation, she had relieved toe pain and good sleep. Her right foot has the want-to-move sensation al about 1 week, the toe pain disappeared and the toes were slightly movable at one month after operation. Her toe strength was up to grade 3 al three months after operation, and she could move out of bed. limpingly but walkably at 6 months after operation. The EMG examination on March 16. 2005 showed that the latent period of the motor end of
出处
《中国临床康复》
CSCD
北大核心
2005年第18期46-48,共3页
Chinese Journal of Clinical Rehabilitation
