经皮神经电刺激对周围神经侧侧缝合后神经再生作用的实验研究

The effects of transcutaneous electrical nerve stimulation on peripheral nerve regeneration after side-to-side neurorrhaphy

目的:研究经皮神经电刺激对周围神经侧侧缝合后神经再生的影响。方法:健康大耳白兔18只,显露坐骨神经及其分叉处,胫神经和腓总神经相邻神经束膜及外膜缝合。将动物肢体分为实验侧与对照侧。实验侧术后第2天,经皮神经电刺激右下肢,刺激参数:方波,波长0.3ms,频率5Hz,电流峰值3—10mA。刺激时间:每日1次,每次30min,持续6周。左后肢不给予电刺激。实验动物分组:A组(术后电刺激3周),B组(术后电刺激6周),C组(术后电刺激16周);每组6只。结果:通过观察电镜、肌电图,实验侧明显优于对照侧。神经侧侧吻合各组在各时间点依次切开原手术切口,检测C组动物腓总神经的运动传导速度,CAMP的振幅及潜伏期,实验侧神经传导速度及CAMP振幅均优于对照侧,两者差异有显著性意义(P<0.05)。实验侧CAMP的潜伏期慢于对照侧,两者差异无显著性意义(P>0.05)。切断各组标本,距吻合口处下方5mm,腓总神经中再生有髓纤维数目实验侧再生有髓纤维均多于对照侧,两者差异有显著性意义(P<0.05)。结论:神经侧侧吻合后有神经侧支发芽生长,可作为修复神经损伤的一种方法;经皮神经电刺激在提高神经侧侧吻合后神经侧支发芽能力有积极作用。

Objective： To study the effect of transcutaneous electrical nerve stimulation（TENS） on peripheral nerve regeneration after side-to-side neurorrhaphy. Method： Eighteen rabbits, regardless of sex, were used （weight 2-2.5kg）. The distal segment of the common peroneal nerves on both legs were sutured to the same side tibial nerve with epineural window, in an side-to-side neurorrhaphy. TENS was given to the right hindlimb postoperatively. The stimulation was applied to the animals for 30 min every day beginning a day after the nerve repair. The stimulation frequency was 2Hz, the current intensities ranged from 8 mA to 10 mA, and the wave-length was 0.4ms. Eighteen rabbits were randomly divided into 3 grous： namely 3w, 6w and 16w （n=8）. Result： Investigation with electron microscope, electromyographic showed the treatment side were better recovered than the contral side. Electromyographic： On the treatment side, the counting rate of motor nerve measured was 40.60±12.49m/s, it was 22.50±7.12m/s on the control side which had significant difference （P〈0.05） by paired T test. The mean potential amplitude measured was 10.75±1.22mV and on the control side, it was 8.28±2.17mV. The mean amplitude of the treatment side was higher than the control side and the difference was statistically significant （P〈0.05） by paired T test. The latent period of CAMP had no significant difference （P〉0.05） on both sides. Conclusion： The existence of collateral sprouting is proved in the experimental study, TENS has beneficial influence on promoting peripheral nerve collateral sprouting after side-to-side neurorrhaphy.