课题背景：课题是第一作者在新疆医科大学攻读博士后项目的一部分，获新疆维吾尔自治区高校科研计划重点项目基金资助，编号XJEDU2006I33，主要研究内容是比较嗅黏膜嗅鞘细胞移植和嗅黏膜移植对大鼠脊髓损伤修复的影响。

应用要点：①采用改良Nash差速贴壁法成功获得移植所需的嗅鞘细胞，方法简单经济，为课题下一步实验奠定基础。②实验所用细胞取自嗅黏膜，不需开颅取嗅鞘，使人的自体嗅黏膜嗅鞘细胞移植修复脊髓损伤更好的应用于临床。

术语解析：差速贴壁法是利用成纤维细胞、星形胶质细胞和成鞘细胞的贴壁时间不同而将它们分离，成纤维细胞的贴壁能力强，在细胞接种1 h之内就可直接贴壁在未被包被的光滑玻璃平面上，星形胶质细胞一般在接种的24 h左右贴壁，而嗅鞘细胞则需要96~120 h内贴壁，采用此法嗅鞘细胞的分离率可达93%。

摘要
目的：目前国际上应用最广泛的神经功能评估标准是2000年美国脊髓损伤学会制定的ASIA标准。通过实践作者发现ASIA标准主要偏重于神经学检查的评估，对于植物神经功能如大小便功能、出汗及皮肤营养等功能性的情况不能很好的评估。作者也曾经制定了ASIA标准的功能观察补充表，虽然此表能够较好的反映出脊髓损伤患者嗅鞘细胞移植术后植物神经功能的变化，但是必须要和ASIA标准同时使用，互为补充，使用较为繁琐。观察北京西山脊髓功能量表的使用效果。
方法：选择2007-07/11来源于全国各地的陈旧性脊髓损伤患者21例，男17例，女4例，年龄8~54岁，损伤时间0.5~18年。受伤原因：创伤性脊髓损伤17例，手术创伤1例，生物源性损伤即脊髓炎3例。损伤节段：颈段8例，胸腰段13例。脊髓损伤程度：14例为完全性脊髓损伤，7例为不完全性脊髓损伤。13例曾行脊髓减压手术治疗。21例均接受过不同种类的神经营养因子等治疗。患者自愿接受细胞移植治疗并签自愿接受协议书。4~6个月中期引产胚胎由家属自愿捐献，并经过医院伦理委员会批准。取胚胎嗅球，经细胞分离、培养、纯化7~14 d，最后消化成单细胞混悬液，然后在手术显微镜下移植到患者损伤脊髓区域的上下方。术后1~2个月，采用北京西山医院脊髓损伤功能量表进行术前和术后评定对比，该量表共9大项16小项，采用4分制，正常3分，最差为0分，总分0~48分，0~16分为重度残障，17~32分为中度残障，33~47分为轻度残障，48分正常，能全面地体现患者的功能变化，不仅包括运动感觉的变化，还包括了膀胱、直肠、肌张力、皮肤营养状况、泌汗、性功能、疼痛、生存和生活质量的评价。
结果：21例患者均进入结果分析。嗅鞘细胞移植术后1~2个月，21例患者的脊髓功能评分都有明显提高（术前：21.33±10.29，术后：25.19±11.16，P < 0.01）
结论：西山医院脊髓功能量表能较全面的反映出术后脊髓患者功能的变化，使用较简便。
关键词：脊髓损伤；嗅鞘细胞；细胞移植；功能评价

刘超，郑遵成，高瑞，张林，张坤，张磊，魏树刚，张立清，匡乃峰，宋延军.嗅鞘细胞移植术后脊髓损伤患者功能的评价[J].中国组织工程研究与临床康复，2008，12(16):3037-3040
[www.zglckf.com/zglckf/ejournal/upfiles/08-16/16k-3037(ps).pdf]

Neurofunctional evaluation in spinal cord injury patients after olfactory ensheathing cell transplantation

Abstract

AIM：Now the American Spinal Injury Association (ASIA) scoring standard formulated in 2000 is generally utilized internationally. But according to the practice, author find that ASIA standard is major for the evaluation of neurological examination, but is not enough for the evaluation of autonomic nerve function, such as urination and defecation function, sweating and skin. Author had formulated the additional function observation scale for ASIA. Although this additional scale can reflect the changes of the autonomic nerve function after the transplantation of olfactory ensheathing cells, the additional scale must be used with ASIA at the same time, so it is very complex. We observe the effects of the spinal cord injury functional rating scale of Xishan Hospital.
METHODS: Totally 21 patients with old spinal cord injury were selected from July to November 2007, who came from all over the country, including 17 males and 4 females, aged 8-54 years. The disease course was 0.5-18 years. Causes of injury included traumatic cord injury in 17 cases, iatrogenic cord injury in 1 case and myelitis in 3 cases. The injury sites were cervical segment (n=8), thoracic segment and lumbar segment (n=13). There were 14 cases of complete spinal cord injury and 7 cases of incomplete spinal cord injury. There were 13 cases who had been received the decompression procedure. Twenty-one patients had received the treatment of various neurotrophic factors. All the patients were voluntary to receive transplantation of the olfactory ensheathing cells and signed the informed consent. Olfactory bulb of aborted fetus (4-6 months induction of labour in second trimester, family member was voluntary to donate, Ethics Committee of hospital licensed) was digested into single olfactory ensheathing cells, which were then cultured and purified for 7-14 days, and finally made into single cell suspension. Then the cultured olfactory ensheathing cell suspension was transplanted into corresponding regions using microscope. Comparison was performed at preoperative and postoperative 1-2 months by the spinal cord injury functional rating scale of Xishan Hospital. Xishan hospital spinal cord injury functional rating scale includes 9 categories with 16 items in total, deploy 4 points, 3 points as normal, the lowest score is 0 point. The total score is 48 ponits. Patients with the score ranged from 0 to 16 points represented severe degree of functional handicap (significant impact on daily life); patients with the score ranged from 17 to 32 points meant moderate degree of functional handicap (some dependency indicated); patients with the score ranged from 33 to 47 points is mild degree of functional handicap (mostly independent); patients with the score of 48 points had normal function. This scale can roundly reflect the changes of neurological function. This scale not only involves sensory function, motor function, but also bladder control, bowel control, muscular tension, sweating, skin condition, pain, sexual function and the quality of life.
RESULTS: Twenty-one patients were involved in the result analysis. Scoring of 21 patients with old spinal cord injury neurological function by Xishan Hospital spinal cord injury functional rating scale was higher 1-2 months after olfactory ensheathing cell transplantation (Preoperative: 21.33±10.29，postoperative：25.19±11.16，P < 0.01) .
CONCLUSION: Xishan Hospital spinal cord injury functional rating scale can completely represent the changes in spinal cord function in postoperative patients. It is simple and convenient.

Liu C, Zheng ZC, Gao R, Zhang L, Zhang K, Zhang L, Wei SG, Zhang LQ, Kuang NF, Song YJ.Neurofunctional evaluation in spinal cord injury patients after olfactory ensheathing cell transplantation.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(16):3037-3040(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-16/16k-3037(ps).pdf]