部分束支移位治疗臂丛神经根性损伤神经截取限度的实验研究

An experiment study on the limit of fascicular harvest in partial nerve transfer in treatment of brachial plexus root injuries

目的研究不同程度切断大鼠尺神经主干近段对肢体功能的影响,以判断截取神经的限度。方法对120只Wistar大鼠在上臂肌皮神经入肌水平不同程度切断尺神经(分别切断1/6,1/3,1/2,2/3及全部),术后6～8周观察大鼠的行为变化,尺神经电生理变化,尺侧腕屈肌及小指展肌的肌湿重比及肌细胞超微结构的改变。结果尺神经切断少于1/3,在较短时间内可以获得满意的功能恢复；切断1/3～1/2,恢复较慢,有不可逆损伤表现；切断2/3以上会产生严重的不可逆损伤表现。结论上臂尺神经切取少于1/3比较安全,切取1/2虽有一定程度的功能恢复但仍有较严重的不可逆功能障碍,临床上应谨慎。

Objective To investigate the largest harvestable portion of the unlar nerve without causing limb functional deficit for partial fascicle nerve transfer. Matheds 120 Wister rats were used. Different portions of the ulnar nerve （1/6, 1/3, 1/2, 2/3, and entire nerve） were cut at the level where the musculocutaneous nerve enters the biceps brachia. After 6 to 8 weeks behavioral test, electrophysiologic test, muscle weight measurement of flexor carpi ulnaxis and abductor digiti minimi manus, and ultrastructural observation were carried out. Results When less than 1/3 of the ulnar nerve is cut, functional deficit could return to normal within a short period of time. When 1/3 to 1/2 of the nerve fascicles were cut, more obvious functional deficits were noted with a prolonged recovery time and some irreversible changes. When more than 2/3 of the ulnar nerve was cut, severe irreversible functional loss occurred. Conclusion Harvesting less than 1/3 fascicles of the ulnar nerve at the upper ann level is relatively safe. However, caution must be used when consider taking more than 1/2 of the nerve in that severe and irreversible functional deficit can occur.