周围神经端侧缝合后神经再生及其趋化性的实验研究

Nerve regeneration and neurotropism following end-to-side neurorrhaphy： an experimental study

目的 进一步验证周围神经端侧缝合的有效性，初步探讨端侧缝合后神经再生的趋化性问题。方法 雌性清洁级SD大鼠10只20侧，实验分3组，分别为神经端侧缝合组、正常对照组、切断对照组。神经缝合后5个月采用电生理、组织学、电镜等方法，观测再生神经纤维及其靶器官结构功能的改变；乙酰胆碱酯酶染色观测再生运动神经纤维及比例。结果 端侧组肱二头肌复合肌肉动作电位的（CMAP）潜伏期较正常组减慢64％，最大波幅为正常组的27％。肱二头肌肌湿重为正常组的72％，肌纤维横截面积与正常组无明显差异。端侧组肌皮神经有髓神经纤维计数占正常组的44．5％，有髓神经纤维髓鞘厚度、最大直径、最小直径分别占正常组的85．9％、77．3％和65．5％。乙酰胆碱酯酶染色示端侧组肌皮神经主干运动神经纤维比例为[（0．39±0．07）％，^-x±s，下同]，与正常组的差异无统计学意义；肱二头肌肌支运动神经纤维比例为（0．38±0．07）％，与正常组比较差异有统计学意义（P〉0．01）。结论 周围神经端侧缝合后有相当数目的再生神经纤维，但以髓鞘薄，直径小的纤维为主，同时能有效防止肌肉萎缩。周围神经端侧缝合后神经侧方出芽对特定靶器官的趋化性不明显。

Objective To examine the effects of end-to-side neurorrhaphy on peripheral nerve regeneration, and to detect whether there is neurotropism following end-to-side neurorrhaphy. Methods Ten female Spragne-Dawley rots （20 upper limbs） were divided into 3 groups：end-to-side neurorrhaphy group, normal group and nerve transection group. Five months post operation, evaluations including wet weight of biceps hrachii, electrophysiology, histology, electron microecopie observation, and acetyleholinestorase （AchE） stain were conducted. Results In the end-to-side neurorrhaphy group, latency of compound muscle action potential （CMAP） was prolonged 64% as compared to that in the normal control group, while CMAP amplitude was 27% of that of normal control group. Wet weight of biceps was 72% of that of normal control group, while the crosssectional area of the muscles was not different from that of normal control group. Myelinated nerve fiber count was 44.5% as compared to normal control group. Myelin sheath thickness, the minimal and maximal nerve fiber diameter in end-to-side neurorrhaphy group was 85.9% ,77.3% and 65.5% of the normal control group. Ache staining showed that in the end-to-side neurorrhaphy group the percentage of motor fibers of musculocutaneous nerve main branch was 0.39±0.07, not different from normal control group. The percentage of motor fibers of the biceps muscle branch was 0.38±0.07, being significantly different from the normal control group. 1. There are a certain amount of regenerating nerve fibers following end-to-side neurordaphy regenerations most of which are small diameter fibers with thin myelin sheath. End-to-side neurorrhaphy can prevent muscle atrophy. 2. Neurotropism in collateral spouting after end-to-side neurorrhaphy is not significant.