端侧缝合加搭桥对周围神经再生的影响

Peripheral nerve regeneration after termino-lateral neurorrhaphy combined with distal nerve bridging

目的建立周围神经端侧缝合加搭桥的动物模型,比较其与端端缝合及单纯端侧缝合对神经再生的影响。方法SD大鼠45只,随机均分为3组:端端缝合组(A组)、端侧缝合组(B组)、端侧缝合加搭桥组(C组)。分别于术后2、8、16周对再生神经及正常对照行电生理、组织学及超微结构观察,分析并比较神经传导速度(NCV)、复合肌肉动作电位(CMAP)、神经纤维计数(NFC)、神经超微结构等指标,行相应的统计学处理。结果C组在术后8周及16周时,再生神经的NCV、NFC、纤维形态、支配肌肉的CMAP等指标均优于B组(P<0.01),但不如A组。结论周围神经端侧缝合加搭桥后的再生效果明显优于单纯端侧缝合,但与端端缝合仍存在差距。

Objective To set up animal model of termino-lateral neurorrhaphy combined with distal nerve bridging, and to compare on the efficiency of nerve regeneration with that of end-to-end neurorrhaphy and termino-lateral neurorrhaphy. Methods 45 SD rats were randomized into 3 groups: end-to-end neurorrhaphy group (group A); termino-lateral neurorrhaphy group (group B); ternino-lateral neurorrhaphy combined with distal nerve bridging group (group C). Electromyographic, histological and ultramicroscopic analysis were performed in 2, 8 and 16 weeks postoperatively. The nerve conduct velocity(NCV), amplitude of compound muscle action potential(CMAP), myelinated nerve fiber counts(NFC) and ultramicrostructure were studied and processed statistical analysis. Results The NCV,NFC and morphologic study of regenerated myelin and CMAP were all better in group C than in group B (P<0.01) 8 and 16 weeks postoperatively, but not up to Group A . Conclusions Peripheral nerve regeneration is better when the distal nerve bridge is performed after termino-lateral neurorrhaphy, but this modified termino-lateral neurorrhaphy is still not so efficient as the end-to-end neurorrhaphy.