应用透明质酸钠凝胶和自体静脉血管包绕减少吻合口局部瘢痕增生

Application of sodium hyaluronate gel and autogenous vein wrapping in reducing the local scar hyperplasia at stoma

目的:应用透明质酸钠凝胶和自体静脉血管包绕在缝合口处观察吻合口处瘢痕增生的情况。方法:实验于2002-05/2003-05在青岛大学医学院附属医院骨科创伤中心完成。健康SD大鼠60只,随机分为透明质酸钠凝胶组和血管组,每组30只。透明质酸钠凝胶组大鼠,分别切断两侧坐骨神经,并切去2m m神经段造成缺损,一侧单纯行常规外膜缝合做为对照侧,另一侧常规外膜缝合后,吻合口及局部用透明质酸钠凝胶均匀涂抹,做为实验侧;血管组同法切断大鼠坐骨神经,一侧单纯外膜缝合做为对照侧,另一侧常规外膜缝合后,吻合口及局部用自体静脉血管包绕,做为实验侧。两组标记后分笼喂养。术后4,8,12周分别对每组中10只大鼠神经修复处,进行局部观察,电生理检测,并切取神经组织进行组织学观察和有髓神经纤维再生分析。结果:实验大鼠60只均进入结果分析。①术后4,8,12周时透明质酸钠凝胶组和血管组肉眼形态学、组织学观察瘢痕明显少于单纯缝合组。②术后4,8,12周时电生理测试两组运动电位的潜伏期实验侧明显短于对照侧[透明质酸钠凝胶组:实验侧(2.41±0.32),(1.54±0.15),(1.31±0.25)ms,对照侧(3.96±0.72),(2.63±0.65),(2.0±0.72)m s;血管组:实验侧(2.20±0.51),(1.60±0.17),(1.15±0.75)m s,对照侧(4.02±0.51),(3.01±0.72),(2.7±0.65)ms,P<0.01],而透明质酸钠凝胶组和血管组的动作电位的波幅实验侧明显高于对照侧[透明质酸钠凝胶组:实验侧(11.62±0.76),(15.7±0.88),(16.22±0.38)mV,对照侧(9.65±0.65),(12.3±0.65),(14.2±0.55)m s;血管组:实验侧(10.59±0.66),(15.91±0.72),(16.10±0.12)m V,对照侧(8.65±0.65),(13.0±0.55),(14.1±0.75)m s,P<0.01]。③组织图像分析系统显示两组的有髓神经纤维再生率及有髓神经纤维所占面积比例实验侧明显优于对照侧[透明质酸钠凝胶组:(53.22±1.89)%,(76.55±1.32)%,(89.62±2.18)%和(45.36±1.69)%,(78.56±1.56)%,(87.61±0.52)血管组:(54.21±1.37)%,(75.21±1.56)%,(89.95±1.35)%和(46.67±1.56)%,(77.67±1.67)%,(87.72±1.96)%,P<0.01]。④透明质酸钠凝胶组和血管组各项检查均无明显差异(P>0.05)。结论:周围神经损伤修复术中,局部应用透明质酸钠凝胶或局部缝合口用自体静脉血管包绕,可明显减少缝合口处瘢痕组织的形成。

AIM： To observe the scar hyperplasia at stoma by using sodium hyaluronate gel and autogenous vein wrapping around the site of neurorrhaphy, METHODS： The experiment was carried out in the Trauma Center of the Department of Orthopaedics, Affiated Hospital of Qingdao Medical College from May 2002 to May 2003, Sixty healthy adult Sprague-Dawley rats were randomly assigned into sodium hyaluronate gel group （n=30） and vascular group （n=30）. After bilateral sciatic nerves were transected, 2-mm nerve defects were achieved. One side of sciatic defects in both groups were repaired by using an eplneural suture and acted as self-control, The other side nerve defects in the sodium hyaluronate gel group were repaired with epineural suture and sodium hyaluronate were applied around the site of neurorrhaphy, The other side of nerve defects in the vascular group repaired with epineural suture and autogenous veins were used to wrap the neurorrhaphy, Macroscopic and histological evaluations of scarring and nerve regeneration in the repaired sites were＇ performed at postoperative 4, 8 and 12 weeks, Electrophysiologic examinations were used to evaluate the function of repaired nerves in both groups, RESULTS： All the 60 rats were involved in the analysis of resulus, ① At postoperative 4, 8 and 12 weeks, the morphological and histological observations with naked eyes showed that the scars were obviously fewer in the sodium hyaluronate gel group than in the simple suture group, ② At pOstoperative 4, 8 and 12 weeks, the electrophysiologic examinations revealed that the latencies of action potential were at the treated side than at the control side in both groups [sodium hyaluronate gel group： treated side： （2.41±0,32）, （1.54±0.15）, （1.31±0.25） ms, control side： （3.96±0.72）, （2.63±0.65）, （2.0±0.72） ms; vascular group： treated side： （2.20±0.51）, （1.60±0.17）, （1.15±0.75） ms, control side： （4.02±0.51）, （3.01±0.72）, （2.7 ±0.65） ms, P〈 0.01], but the wave amplitudes of action potentials were markedly higher at the treated sides than at the control side in both groups [sodium hyaluronate gel group： treated side： （11.62±0.76）, （15.7±0.88）, （16.22±0.38） mV, control side： （9.65±0.65）, （12.3±0.65）, （14.2±0.55） mV; vascular group： treated side： （10.59±0.66）, （15.91±0.72）, （16.10±0.12） mV, control side： （8.65±0.65）, （13.0±0.55）, （14.1±0.75） ms, P 〈 0.01]. ③ The histological imaging analysis system showed that the regeneration ratio and area of myelinated nerve fiber at treated side were superior to those at control side in both groups [sodium hyaluronate gel group： （53.22±1.89）%, （76.55±1.32）%, （89.62±2.18）%; （45.36±1.69）%, （78.56±1.56）%, （87.61±0.52）%; vascular group： （54.21±1.37）%, （75.21±1.56）%, （89.95±1.35）%; （46.67±1.56）%, （77.67±1.67）%, （87.72±1.96）%, P〈0.01]. ④ There were no significant differences in the results of the examinalions between the sodium hyaluronate gel group and vascular group （P〉0.05）. CONCLUSION： In the repair of peripheral nerve injuries, the local applications of sodium hyaluronate gel or autogenous vein wrapping around the site of neurorrhaphy can obviously reduce the formation of scar tissue at suture.