定量评估经皮神经电刺激促进周围神经的再生和功能恢复

Quantitative evaluation of transcutaneous electric stimulation for promoting peripheral nerve regeneration and functional recovery

目的:探讨经皮电刺激对周围神经损伤后组织修复和功能恢复的作用,以神经传导速度为量化恢复指标,以髓鞘增生数目定量分析再生神经纤维数目。方法:实验于1998-09/1999-06在复旦大学附属华山医院实验动物部和显微外科实验室、复旦大学上海医学院手外科研究所肌电图研究室、复旦大学上海医学院电镜中心和病理实验室完成。雄性SD大鼠20只随机分成2组,每组10只。用显微外科手术造成大鼠坐骨神经损伤模型后电刺激组行神经吻合术并进行经皮电刺激,对照组只固定于和电刺激组相同的固定装置上,不进行干预。采用电生理学方法和组织学方法分别观察经皮电刺激对损伤周围神经的神经电位参数和髓鞘结构及数目的影响。结果:实验过程中对照组1只大鼠和电刺激组2只大鼠在麻醉过程中死亡,进入结果分析对照组9只大鼠,电刺激组8只大鼠。①电刺激组大鼠受损坐骨神经的潜伏期较对照组缩短[(0.58±0.33)ms,(2.27±0.88)ms,(t=5.12,P<0.001)]。电刺激组的神经传导速度较对照组增快[(21.44±8.31)m/s,(16.74±22.82)m/s,P>0.05],波幅低于对照组[(1.95±1.56)mV,(6.64±8.42)mV,P>0.05]。②电刺激组可见大量新生髓鞘,其数目较对照组明显增多[9900.86±1433.65,6505.83±779.50,(t=5.16,P<0.001)]。结论:电刺激定量检测的大鼠坐骨神经潜伏期缩短,神经髓鞘计数增高。说明电刺激可能通过促进许旺细胞增殖和髓鞘形成来改善受损周围神经再生和修复的作用。

AIM:To study the effect of transcutaneous electric stimulation on peripheral nerve regeneration and functional recovery,and analyze the number of regenerated nerve fiber with nerve conduction velocity as the recovery indexes and the number of proliferated myelin sheath.METHODS:The experiment was finished in the Animal Experiment Division and the Laboratory of Microsurgery,Huashan Hospital of Fudan University,and the Laboratory of Electrmyogram,Institute of Hand Surgery and the Morphology Center and the Laboratory of Pathology,Shanghai Medical College of Fudan University from September 1998 to June 1999.Twenty male SD rats were assigned to receive anastomosis microsurgery and transcutaneous electric stimulation following sciatic nerve transection(transcutaneous electric stimulation group,n=10),or nothing(control group,n=10).The effects of the transcutaneous electric stimulation on the electrophysiological parameters and the structure and number of myelin sheaths in injured peripheral nerve were observed by using electrophysiological and histological methods.RESULTS:One rat in control group and two rats in transcutaneous electric stimulation group died,so nine rats in control group and eight rats in transcutaneous electric stimulation group were involved in the result analysis.①There was significant shortening in latency of injured sciatic nerve in the transcutaneous electric stimulation group as compared with control group[(0.58±0.33),(2.27±0.88) ms,t=5.12, P< 0.001].The nerve conduction velocity was faster and the amplitude was lower in the transcutaneous electric stimulation group than that in control group[(21.44±8.31),(16.74±22.82) m/s;(1.95±1.56),(6.64±8.42) mV;P >0.05].②There were more myelin sheaths in injured sciatic nerve of the transcutaneous electric stimulation rats (9 900.86±1 433.65) as compared with those of the control rats (6 505.83±779.50),statistic difference was found between the two groups (t=5.16,P< 0.001).CONCLUSION:The latency of injured sciatic nerve is shortened and the number of myelin sheaths is increased detected by using transcutaneous electric stimulation,which indicates transcutaneous electric stimulation may promote the regeneration and reparation of injured peripheral nerve through enhancing the proliferation of Schwann cells and the formation of nerve myelin sheaths.