神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究

The combination of proximal end-to-end neurorrhaphy and distal end-to-side or side-to-slde neurorrhaphy to improve functional recovery after nerve repair:an experimental study

目的对无缺损的周围神经高位损伤,提出高位端端与低位端侧或侧侧缝合相结合的新方法,观察神经再生和靶器官的恢复情况。方法SD大鼠80只,高位切断左侧胫神经。随机分为5组:A组:胫神经两断端行端端缝合,远端于膝关节水平与腓神经干行侧侧缝合。B组:断端处理同A组,远端移植正中神经作胫腓神经干之间的端侧桥接缝合。C组:单纯作断端的端端吻合。D组:胫神经干近端结扎并固定,远端与腓神经干行侧侧缝合。E组:近端处理同D组,远端切除部分神经段后,与腓神经干行端侧缝合。术后行肌电图检查及组织学观察并作统计学分析。结果术后早期(4周)D、E组有神经再生,术后12周A、B组的神经再生、传导功能及靶肌肉和运动终板的恢复情况均优于C、D、E组。结论高位端端与低位端侧或侧侧缝合相结合的方法,可尽早恢复对靶组织的营养和神经再支配,为高位缝合处高质量神经的长入赢得时间,提高了有效功能的恢复。

Objective To investigate the effectiveness of nerve regeneration and target muscles recovery in high level nerve injury treated with combined proximal end-to-end neuron-haphy and distal end-to-side or side-to-side neurorrhaphy. Methods The left tihial nerve of 80 female SD rats was transected proximally. The animals were randomly divided into five groups. In group A, the transected fibial nerve were sutured at the transeeted site in an end-to-end fashion. At the knee joint level, the windowed tibial nerve was sutured with the windowed neighboring peroneal nerve in a side-to-side fashion. In group B, the proximal eoaptation was same as group A. At the knee joint level, a segment of 3 mm median nerve was harvested and bridged between the peroneal nerve and the distal part of the tibial nerve in an end-to-side fashion. In group C, only end-to-end neurorrhaphy of the tibial nerve was done at the transection site. In group D, the proximal end of the tibial nerve was ligated, reversed and sutured into neighboring muscles while the distal part was windowed at the knee joint level and sutured side-to-side with the windowed peroneal nerve. In group E, the proximal end of the fibial nerve was dealt with same as group D while a certain length of the distal tihial nerve was resected to the knee joint level and then sutured end-to-side with the windowed peroneal nerve. Assessment of nerve regeneration was carried out using electrophysiological and histological examination, electron microscopic evaluation and image analysis. Results Regenerating nerve fibers were observed in groups D and E at 4 weeks after the operation. The quantity and quality of the regenerated nerve fibers, conducting capacity, and the recovery of muscle and motor endplates in groups A and B were much better than those in groups C, D and E at 12 weeks after the operation. Conclusion Combined proximal end-to-end neurorrhaphy and distal end-to-side or side-to-side neurorrhaphy can provide early neurotropie support to the target muscles. This buys time for nerve regeneration in high level injuries, protects the target organs and results in more effective functional recovery.