甲钴胺对皮肤移植后神经再支配的影响

Effect of methycobal on reinnervation after skin grafting

目的:为改善植皮后感觉功能恢复,研究猪皮肤移植后神经纤维再生及甲钴胺对其再生的促进作用。方法:实验于2003-09/2004-04在上海第二医科大学动物房完成。选择8头白色小猪,随机分为两组,于背部分别给予不同厚度皮片移植,一组术后注射甲钴胺,一组术后不给任何处理。术后2,4,8周取材,切取所植皮肤,切片进行嗜银染色,观察神经再生的情况。显微镜下对神经纤维数量进行计数并进行统计学检验,两组结果进行比较。结果:使用甲钴胺组的神经密度同未使用组做团体t检验,2周时差异有显著性意义(t=2.85;P=0.013);4,8周差异均无显著性意义(t=1.015,1.16;P=0.33,0.27)。中厚皮片同刃厚皮片相比2,4周差异无显著性意义(t=1.19,1.21;P=0.25,0.24),8周时差异有显著性意义(t=2.26;P=0.04)。结论:甲钴胺对皮肤移植后神经再支配有促进作用,尤以植皮后早期较为明显。中厚皮片的神经再生优于刃厚皮片。

AIM:To study the nerve fiber regeneration after pig skin grafting and the promotive effect of methycobal on it so as to improve the sensory functional recovery after skin grafting.METHODS:The experiment was conducted in the room for animals in Shanghai Second Medical University from September 2003 to April 2004.Eight white pigs were selected to divide into two groups randomly and then were given skin grafting of different depth.One group was given methycobal after operation(treatment group) the other one was given nothing(control group).The samples of skin were harvested after 2,4 and 8 weeks.The sections of skin were excised to observe the reconstruction nerve by silver staining.The number of nerve fibers was counted under microscope and tested statistically,and the data of two groups were compared.RESULTS:The density of nerves in treatment group was compared with that of the control group with t test.The difference in the density of nerves between the two groups was significant after 2 weeks(t=2.85,P=0.013),but insignificant after 4 and 8 weeks(t=1.015,1.16,P=0.33,0.27).The density of nerve between of intermediate split thickness skin graft and razor thin skin graft was insignificantly different after 2 and 4 weeks(t=1.19,1.21;P=0.25,0.24) and significantly different after 8 weeks(t=2.26,P=0.04).CONCLUSION:Methycobal can promote the reinnervation after skin grafting,especially in the early stage.Neural regeneration is better in intermediate split thickness skin graft than in razor thin skin graft.