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目的观察局部应用鼠神经生长因子(NGF)对大张移植皮片感觉神经末梢再生过程的影响。方法选择中小面积烧伤和需行瘢痕整形术的成年患者48例共60处创面,随机分为NGF组、对照组(各30处)。NGF组术前采用含鼠NGF的等渗盐水(9000 AU/100 ml)纱布包裹皮片,术后用100ml该盐水行皮片下冲洗;术后20d起,于移植皮片下多点微量注射NGF,隔日1次,持续1个月。对照组单纯用等量等渗盐水作相同处理。检测术后12个月内移植皮片的两点辨别比并行皮片感觉功能评级。采集再次行整形术患者的术区组织标本行组织病理学检查,观察神经末梢再生和分布情况。结果术后12个月,NGF组17处皮片达S_4级、两点辨别比为1.11±0.14,而对照组仅5处皮片达S_4级、两点辨别比为1.56±0.73(P<0.05或P<0.01);其余各时相点2项指标组间差异与之相似。术后6个月,NGF组可在皮片移植区的微血管床、瘢痕结节旁的疏松组织间隙和移植皮片下的瘢痕组织中,见到丰富的感觉神经末梢,附件结构也较为完整;对照组上述组织中神经末梢纤细,稀少。结论局部应用NGF可加速感觉神经末梢的再生,促进移植皮片的感觉恢复。
Objective To observe the effect of local application of nerve growth factor (NGF) on the regeneration process of sensory nerve endings in the grafts. Methods Forty-eight wounds were randomly divided into NGF group and control group (30 in each group). The NGF group was treated with isotonic saline (9000 AU / 100 ml) gauze containing rat NGF preoperatively and then subcutaneously with 100 ml of saline after operation. After 20 days, multiple microinjection NGF, every other day for 1 month. The control group was treated with the same amount of isotonic saline for the same treatment. The two-point discrimination of the transplanted skin grafts was compared with the parallel skin sensory function rating within 12 months after surgery. Histopathological examination was performed in surgical specimens of patients who underwent plastic surgery again to observe the regeneration and distribution of nerve endings. Results At the 12th month after operation, 17 of 16 skin specimens in NGF group reached S_4 level with a discrimination ratio of 1.11 ± 0.14 in control group and 5 in control skin reached S_4 level with a discrimination of 1.56 ± 0.73 (P <0.05) Or P <0.01). The rest of the time points two groups of indicators with similar differences. At 6 months after operation, the NGF group showed abundant sensory nerve endings in the microvascular bed in the skin grafting area, the loose interstitial tissue beside the scar nodules and the scar tissue under the transplanted skin graft. The structure of the appendix was relatively intact. The control group in the above nerve endings thin, sparse. Conclusion Topical application of NGF can accelerate the regeneration of sensory nerve endings and promote the sensory recovery of transplanted skin.