端侧神经吻合配合NGF修复面神经缺损的实验研究

Experiment on Repairing Facial Nerve Defect Using End-To-Side Neurorrhaphy Combined with NGF

目的:通过对端侧神经吻合术配合神经生长因子(NGF)修复面神经缺损的研究,探索简便、省时、不损伤供神经而又可获得较好神经再生效果的修复神经损伤的新方法。方法:!成年健康新西兰大白兔24只,随机分成3组,每组8只。(1)神经移植组:切断兔面神经的耳眼睑神经分支1.2cm后用神经干移植修复缺损;(2)单纯端侧神经缝合组:切断兔面神经的耳眼睑神经分支1.2cm后不用神经干移植修复,而将其远颅段断端向下吻合于面神经颊上神经分支的侧方,采用外膜、束膜均切开“开窗”的端侧神经吻合术;(3)端侧神经缝合术配合NGF修复神经缺损组:手术处理同(2)组,但在术中及术后配合局部NGF的注射使用。术后4、8、12、16周采用肉眼观察睑裂大小,并作组织学检查,观察吻合口近颅及远颅段的神经轴突数和再生髓鞘的厚度。结果:3组均可见明确的神经再生现象,但统计学上无显著性差异。结论:!端侧神经吻合术可作为一种较好的面神经修复手段,简便、省时、不损伤供神经而又可获得较好的神经再生效果。

Objective： To investigate a new potential method for repairing the facial nerve defect using end-to-side neurorrhaphy combined with nerve growth factor（NGF）. Methods： 24 healthy New Zealand rabbits were randomly divided into three groups （each group contain 8 rabbits）. Nerve grafting group： after sectioning 1.2cm of the division of facial nerve to the eye lid, nerve grafting was used for bridging the defect, End-to-side neurorrhaphy group： instead of nerve grafting, the distal ending was sutured to the lateral face of the buccal branch of facial nerve after removing a small epineural and perineural window. NGF group： end-to-side neurorrhaphy plus nerve growth factor （NGF） injection were used to repair the facial nerve defect of 1.2 cm. Measure of distance between eyelids and histological analysis were employed 4, 8, 12, 16 weeks after surgery. Results： Histological analysis showed that the regeneration of axon was obvious in all three groups. No significant statistic difference was found between 3 groups. Conclusion： End-to-side neurorrhaphy has some advantages in reconstruction and regeneration of facial nerve.