面神经端侧吻合与端端吻合后神经再生质量的比较

End-to-side neurorrhaphy versus end-to-end neurorrhaphy in influencing the quality of facial nerve regeneration

目的:比较面神经损伤后端侧吻合与端端吻合方法效果。方法:在解放军总医院动物中心,用24只新西兰大耳白兔进行实验。左侧上颊神经切断后作端端吻合。右侧上颊神经切断后,远断端与下颊支侧方,外膜开窗处作支间端侧吻合。分别于术后1,2,3个月时作肌电图后取材,作组织学检查。结果:术后1,2个月时,端侧吻合肌电图神经传导速度慢于端端吻合犤1个月时(10.6±2.20),(15.7±2.13)m/s,2个月时(14.4±1.80),(20.80±3.10)m/s,P<0.05犦,术后3个月时端侧吻合肌电图神经传导速度与端端吻合差异无显著性意义犤(22.8±2.40),(23.20±2.14)m/s,P>0.05犦。术后1,2个月时,端侧吻合有髓神经纤维数少于端端吻合犤1个月时(34.16±4.24),(44.28±3.04)个/高倍视野,2个月时(43.64±3.20),(52.84±2.16)个/高倍视野,P<0.05犦,术后3个月时端侧吻合有髓神经纤维数与端端吻合差异无显著性意义犤(64.66±2.48),(66.12±1.96)个/高倍视野,P>0.05犦。结论:面神经断伤作端侧吻合后,早期神经再生质量不及端端吻合优良,晚期效果比较接近。

AIM:To compare the outcomes of end to side neurorrhaphy and end to end neurorrhaphy after facial nerve injury. METHODS:From April 2003 to March 2004 in Center from Animals,General Hospital of Chinese PLA,24 New Zealand flap eared white rabbits were selected for this experiment.The upper cheek branch of facial nerve on right sides was transected and then its distal transected end was sutured to the lower cheek branch nerve with an epineurial window in an end to side fashion.At the same time,the left sides were performed in an end to end fashion.The regeneration of the transected nerves was tested via electromyographic exam for sampling to perform histological examination at postoperative 1,2 and 3 months. RESULTS:As shown by electromyography,the nerve conduction velocity after end to side neurorrhaphy was significantly lower than that after end to end neurorrhaphy at postoperative 1 and 2 months[(10.6±2.20),(15.7±2.13) m/s at 1 month,(14.4±1.80),(20.80±3.10) m/s at 2 months,P< 0.05],however at postoperative 3 months that was insignificantly different after end to side neurorrhaphy and end to end neurorrhaphy[(22.8±2.40),(23.20±2.14) m/s,P >0.05].The number of the myelinated nerve fibers per high power field significantly less after end to side neurorrhaphy than after end to end neurorrhaphy at postoperative 1 and 2 months[(34.16±4.24),(44.28±3.04) at 1 month,(43.64±3.20),(52.84±2.16) at 2 months,P< 0.05],however at postoperative 3 moths that after end to side neurorrhaphy was not significantly different from that after end to end neurorrhaphy[(64.66±2.48),(66.12±1.96),P >0.05].CONCLUSION:The quality of nerve regeneration after end to side neurorrhaphy is inferior to that after end to end neurorrhaphy at early stage,however,it has no difference at late stage.