聚焦式低强度脉冲超声联合富血小板血浆局部注射修复大鼠面神经损伤效果观察

Effect of FLIPU combined with local injection of PRP in repairing facial nerve injury in rats

目的观察聚焦式低强度脉冲超声(FLIPUS)联合富血小板血浆(PRP)局部注射对大鼠面神经损伤的修复效果。方法将20只健康雄性SD大鼠随机分为模型组、PRP组、FLIPUS组及PRP+FLIPUS组,每组5只。各组均建立右侧面神经损伤模型,PRP组于神经损伤处局部注射PRP 50μL,2次/周;FLIPUS组于神经损伤处进行FLIPUS治疗10 min,1次/天;PRP+FLIPUS组参照上法给予PRP局部注射及FLIPUS治疗;模型组不予特殊处理;各组疗程均为28 d。各组术后1~4周每周进行行为学评估,记录胡须运动和瞬目反射评分。各组术前及术后第28天,使用肌电诱发电位仪行右侧面神经电生理检查,记录损伤面神经的最大复合肌肉动作电位(CMAP)振幅并计算R值。各组大鼠处死后取损伤面神经节段组织,HE染色后进行组织病理学观察,同时记录单位面积的轴突数量、直径及面积。结果各组大鼠术后1~4周瞬目反射及胡须运动评分比较P均>0.05。与同组术前比较,各组大鼠术后损伤面神经的最大CMAP振幅均降低(P均<0.05)。与模型组比较,PRP组、FLIPUS组及PRP+FLIPUS组大鼠术后损伤面神经的最大CMAP振幅及R值均升高(P均<0.05),PRP组、FLIPUS组及PRP+FLIPUS组比较差异均无统计学意义(P均>0.05)。与模型组比较,PRP组、FLIPUS组及PRP+FLIPUS组神经束变性、脱髓鞘及轴突空泡化程度减轻,再生轴突增多且神经纤维排列更有序。与模型组比较,PRP组、FLIPUS组及PRP+FLIPUS组大鼠损伤面神经节段组织单位面积内的轴突数量均升高(P均<0.05);PRP组大鼠损伤面神经节段组织单位面积内的轴突直径、轴突面积均高于模型组、FLIPUS组、PRP+FLIPUS组(P均<0.05)。结论FLIPUS联合PRP局部注射对大鼠面神经损伤的修复作用不优于二者单独应用。

Objective To compare the repair effects of focused low-intensity pulse ultrasound(FLIPUS)combined with local injection of platelet-rich plasma(PRP)on facial nerve injury in rats.Methods Twenty healthy male SD rats were randomly divided into the model group,PRP group,FLIPUS group,and PRP+FLIPUS group,with 5 rats in each group.We established the right lateral facial nerve injury models in each group,and rats in the PRP group received local injection of 50μL PRP at the nerve injury site,twice a week;rats in the FLIPUS group received FLIPUS treatment at the site of nerve injury for 10 min,once per day;rats in the PRP+FLIPUS group were treated with local injection of PRP and FLIPUS according to the above method;rats in the model group were not subject to special treatment;and the treatment period for each group was 28 d.Behavioral assessments were conducted weekly after surgery in each group,and scores of beard movement and blink reflex were recorded.Before and on the 28th day after surgery,right lateral nerve electrophysiological examination was performed using an electromyography evoked potential device in each group.The maximum CMAP amplitude of the injured facial nerve was recorded and the R value was calculated.After rats of each group were euthanized,the injured facial nerve segment tissues were taken and stained with HE for histopathological observation.At the same time,the average number,diameter,and area of axons per unit area were recorded.Results There were no significant differences in the blink reflex or beard movement scores in rats at 1-4 weeks after surgery between groups(all P>0.05).Compared with the same group before surgery,the maximum CMAP amplitude of facial nerve injury in rats of each group decreased after surgery(P<0.05),and there were no significant differences among all groups after operation(all P>0.05).Compared with the model group,the R values of the injured facial nerves in the PRP group,FLIPUS group,and PRP+FLIPUS group all increased(all P<0.05),while there was no statistically significant difference between the PRP group,FLIPUS group,and PRP+FLIPUS group(all P>0.05).Compared with the model group,the PRP group,FLIPUS group,and PRP+FLIPUS group showed reduced degree of nerve bundle degeneration,demyelination,and axonal vacuolization,increased number of regenerated axons,and more orderly arrangement of nerve fibers.Compared with the model group,the number of axons per unit area in the injured facial nerve segment tissue of rats in the PRP group,FLIPUS group,and PRP+FLIPUS group increased(all P<0.05);the axon diameter and area per unit area of the injured facial nerve segment tissue in the PRP group rats were higher than those in the model group,FLIPUS group,and PRP+FLIPUS group(all P<0.05).Conclusion The repair effect of FLIPUS combined with local injection of PRP on facial nerve injury in rats is not superior to that of FLIPU and PRP alone.