周围神经端侧动脉套接后神经再生的研究

EXPERIMENTAL STUDY ON PERIPHERAL NERVE REGENERATION AFTER ARTERY SLEEVE ANASTOMOSIS AND END-TO-SIDE SUTURE

目的 研究周围神经端侧动脉套接后神经再生的可能性及其特点。 方法 取 SD大鼠 75只 ,在股骨中下段切断腓神经 ,将近断端逆转 90度包埋于肌肉中。随机分为 5组。 A组 :将截取的左颈总动脉套接于右侧正常胫神经侧方与腓总神经远端 2 mm距离之间 ,缝合部胫神经外膜不予切除 ;B组 :在胫神经套接部外膜开窗 1.0 mm;C组 :腓总神经切断 14天后再予动脉套接 ,余同 B组 ;D组 :同 B组 ,且于动脉套接部注入神经生长因子 (neural growth factor,NGF) 1ml;E组 :将腓总神经远端以端侧缝合形式直接缝合于胫神经的一侧 ,外膜开窗 1.0 mm。术后 4、8和 12周分别行组织学、电镜和神经纤维计数等检查。 结果 4周时 C、D及 E组周边区域有神经纤维轴突和髓鞘再生 ,A组则无神经纤维生长 ;8周时 C、D及 E组再生神经纤维较 B组多 ,E组神经纤维较 C、D组多 ,差异有统计学意义 (P<0 .0 5 ) ;12周时 C、D及 E组神经纤维多于 B组 ,差异有统计学意义 (P<0 .0 5 ) ;C组及 D组有较丰富的神经再生 ,与神经端侧直接吻合的 E组差异无统计学意义 (P>0 .0 5 )。 结论 神经端侧 2

Objective To know the possibility of nerve regeneration after artery sleeve anastomosis and end-to-side suture.Methods Seventy-five SD rats were divided into 5 groups. First, the distal end of severed peroneal nerve was sutured end- to -side with artery sleeve anastomosis with normal nerve tibial trunk in groups A, B, C and D. Second, the tibial epineurium at the suture site was not removed in group A; the epineurium at the suture site was removed(windowing) in group B; the distal end of pre-injured peroneal nerve was sutured after 14 days and windowing was done in group C; and the neural growth factor was injected into artery sleeve and windowing was done in group D. While the distal end of severed peroneal nerve was sutured end to side directly with normal nerve tibial trunk and windowing was done in group E. The histological observation was made and the number of nerve fibers was recorded after 4, 8 and 12 weeks of operation.Results After 4 weeks, there existed the regeneration of axons and myeline sheaths in groups C, D, E, and no nerve fiber regeneration was seen in group A. After 8 weeks, the regenerating nerve fibers were significantly more in groups C, D and E than in group B and in group E than groups C and D(P<0.05). After 12 weeks, the regenerating nerve fibers were significantly more in groups C,D and E than in group B(P<0.05).Conclusion End-to-side coaptation with artery sleeve anastomosis is a new valuable method in repair of peripheral nerve injuries.