臺灣博碩士論文加值系統

　　本研究係以明膠來製備可降解之神經導管，將其植入雌性Spraque-Dawley大鼠截斷坐骨神經10 mm之斷面，藉以評估導管對神經再生之影響。實驗所採用之對照組為未加中藥之明膠神經導管，實驗組為添加葛根之明膠神經導管。導管採用戊二醛進行化學交聯。植管後，將大鼠飼養八週後收成，再以肉眼觀察神經再生情形及導管降解狀況，並以電生理檢測及神經切片組織學分析，來評估神經再生及功能恢復的狀況。我們的研究結果顯示，在肉眼觀察上，兩組皆取得良好神經再生結果，導管降解程度亦皆良好。在電生理評估上，實驗組比對照組的神經功能良好，且已達到統計上的顯著差異。在組織學鏡檢觀察上，實驗組的再生神經組織顯得較為緻密，對照組組織則較為疏鬆。因此我們的結論是，添加葛根的神經導管比未添加葛根之明膠導管，對神經的再生及功能恢復具有助益。

We evaluated a biodegradable gelatin nerve conduit containing Radix Puerariae on peripheral nerve regeneration. In the experimental group, the Radix Puerariae-contained gelatin conduits were used to bridge a 10 mm sciatic nerve defect in 10 Spraque-Dawley rats. Gelatin conduits without Radix Puerariae added were considered as the controls. Histological and electrophysiological techniques were used to evaluate the nerve regeneration. At the conclusion of eight weeks, all rats in both groups acquired successful regeneration across gaps. However, the experimental group had a significantly better performance at peak latency and nerve conduction velocity than the control group. In addition, the experimental group revealed more condensed regenerated axons than the control group. These results indicated that Radix Puerariae could be a beneficial factor for nerve regeneration.

目 錄

第一章 前言 1
第二章 文獻回顧 4
2.1周邊神經損傷 4
　　2.1.1 周邊神經損傷的分類 4
　　　2.1.1.1 Seddon分類法 4
　　　2.1.1.2 Sunderland分類法 5
　　2.1.2 周邊神經損傷的修補技術 5
　　　2.1.2.1斷端縫合術（end-to-end suturing techniques）5
　　　2.1.2.2組織纖維黏合法（Tissue fibrin adhesive techniques） 6
　　　2.1.2.3雷射神經癒合術（Laser nerve repair techniques） 6
　　　2.1.2.4神經移植手術（Nerve grafting operation） 6
　　　2.1.2.5神經導管接合術（Nerve bridging techniques） 7
　2.2 神經與中醫 7
　 2.2.1 神經系統的中醫觀點 7
　　 2.2.1.1神經的中西醫學發展史 7
　　 2.2.1.2 腦髓與神經的關係 9
　　 2.2.1.3 臟腑與神經的關係 9
　　 2.2.1.4 經絡與神經的關係 10
2.2.2 周邊神經損傷的中醫觀點 13
　　 2.2.2.1 周邊神經損傷的中醫證型 13
　　 2.2.2.2 周邊神經損傷的中醫治療 13
　　　 2.2.2.2.1 中藥治療 13
　　　 2.2.2.2.2 針灸治療 14
2.3 製備神經導管的常用生醫材料 14
　 2.3.1 生醫材料的種類 14
　 2.3.2 神經導管材料的選擇條件 15
　 2.3.3神經導管材料各論 16
　　 2.3.3.1膠原蛋白（collagen） 16
　　 2.3.3.2 明膠（Gelatin） 17
　　 2.3.3.3甲殼素（chitin）與幾丁聚醣（chitosan） 18
2.4 交聯與交聯劑 19
　 2.4.1 交聯的作用 19
　 2.4.2 交聯的方法 20
　 2.4.3 化學交聯劑的種類 20
　 2.4.4 交聯方法的比較 21
2.5 藥物控制釋放在神經導管上的應用 22
　 2.5.1 控制釋放的基本概念 22
　 2.5.2 葛根 23
　　 2.5.2.1 葛根簡介 23
　　 2.5.2.2 葛根的神經相關文獻探討 23
第三章 材料與方法 25
3.1 製備葛根濃縮粉末 25
　 3.1.1 目的 25
　 3.1.2 主要材料 25
　 3.1.3 製備方法 25
3.2 製備神經導管 26
　 3.2.1 目的 26
　 3.2.2 主要材料 26
　 3.2.3 製備方法 27
　　 3.2.3.1 製備對照組神經導管 27
　　 3.2.3.2 製備實驗組神經導管 28
3.3 神經導管接合術 29
　 3.3.1 目的 29
　 3.3.2 主要材料 29
　 3.3.3 手術方法 30
3.4觀察大鼠植管後0~8週狀態 31
3.5 觀察神經再生情形及導管降解狀態 31
3.6 神經電生理檢測實驗 32
　 3.6.1 目的 32
　 3.6.2 實驗方法 32
3.7 再生神經組織學切片分析 32
　 3.7.1 目的 32
　 3.7.2 實驗方法 32
第四章 結果 34
4.1葛根濃縮粉末製藥結果 34
4.2神經導管製備結果 34
4.3大鼠植管後0~8週狀態觀察結果 36
　 4.3.1一般性觀察結果 36
　 4.3.2 體重變化與厭食 38
　 4.3.3 自殘 39
4.4觀察神經再生及導管降解狀態結果 41
　 4.4.1 一般性觀察結果 41
　 4.4.2 神經導管降解程度觀察結果 44
　 4.4.3 神經再生觀察結果 45
4.5神經電生理檢測結果 49
　 4.5.1 潛期 49
　 4.5.2 波期 50
　 4.5.3 振幅 51
　 4.5.4 波下面積 52
　 4.5.5 神經傳導速度 53
4.6再生神經組織學切片評估結果 54
　 4.6.1光學顯微鏡40倍鏡檢結果 54
　 4.6.2光學顯微鏡100倍鏡檢結果 56
　 4.6.3光學顯微鏡400倍鏡檢結果 60
　 4.6.4光學顯微鏡1000倍鏡檢結果 63
第五章 討論 66
5.1 藥物 66
5.2 神經導管的製備 67
5.3 大鼠植管後0~8週的狀態觀察 68
5.4 神經電生理評估 69
5.5 再生神經組織學切片評估 70
第六章 結論 72
參考文獻 73
英文摘要 89
作者簡歷 90
謝辭 91


圖　目　錄

圖4.1 葛根濃縮粉末 34
圖4.2 對照組神經導管 35
圖4.3 實驗組神經導管 35
圖4.4 神經導管之比較 36
圖4.5 大鼠植管後0~8週體重變化比較圖 38
圖4.6 大鼠自殘狀態 39
圖4.7 對照組神經再生及神經導管降解圖 42
圖4.8 實驗組神經再生及神經導管降解圖 43
圖4.9 神經導管降解程度比較圖 45
圖4.10 對照組A1大鼠只有微細再生神經出現 46
圖4.11 對照組A8大鼠可觀察到粗大的再生神經 47
圖4.12 實驗組B3大鼠可觀察到粗大的再生神經 47
圖4.13 對照組A4大鼠之分離坐骨神經 48
圖4.14 實驗組B3大鼠之分離坐骨神經 48
圖4.15 潛期比較圖 49
圖4.16 波期比較圖 50
圖4.17 振幅比較圖 51
圖4.18 波下面積比較圖 52
圖4.19 神經傳導速率比較圖 53
圖4.20 實驗組神經切片（縱切面, 40倍） 55
圖4.21 對照組神經切片（橫切面, 40倍） 55
圖4.22 實驗組神經切片（橫切面, 40倍） 56
圖4.23 實驗組神經切片（縱切面, 100倍） 57
圖4.24 對照組神經切片（橫切面, 100倍） 58
圖4.25 實驗組神經切片（橫切面, 100倍） 58
圖4.26 對照組神經切片（斜切面, 100倍） 59
圖4.27 實驗組神經切片（斜切面, 100倍） 59
圖4.28 實驗組神經切片（縱切面, 400倍） 60
圖4.29 對照組神經切片（橫切面, 400倍） 61
圖4.30 實驗組神經切片（橫切面, 400倍） 62
圖4.31 對照組神經切片（橫切面, 1000倍）. 64
圖4.32 實驗組神經切片（橫切面, 1000倍） 65
圖5.1 神經導管內神經再生機制圖 68
圖5.2 動作電位比較圖 71


表　目　錄

表4.1 大鼠植管後0~8週狀態觀察結果 37
表4.2 大鼠植管後厭食數目比較表 39
表4.3 大鼠植管後自殘數目比較表 40
表4.4 神經導管降解程度分級標準 44
表4.5 神經導管降解程度分級結果 44
表4.6 肉眼觀察神經再生結果比較表 46
表4.7 潛期統計結果表 50
表4.8 波期統計結果表 51
表4.9 振幅統計結果表 52
表4.10 波下面積統計結果表 53
表4.11 神經傳導速度統計結果表 54

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