纤维蛋白胶在几丁质管修复面神经缺损中的应用

Application of Fibrin Glue in Facial Nerve Repair

探讨纤维蛋白胶在神经缺损修复中的作用,寻求理想的外科修复方法。15只大耳白兔行单侧颞骨内面神经横断后,缺损为5mm,以几丁质管桥接,并用纤维蛋白胶粘合;神经束膜缝合组用0-0号线缝合,左侧作为正常对照。分别于术后3、5月行神经电生理测试。电生理结果显示随着修复时间的延长,再生面神经潜伏期(Incubation period,IP)逐渐缩短,动作电位波幅(Amplitude,AMP)逐渐增高,神经-肌肉传导速度(Nerve-muscleconduction velocity,NMCV)逐渐增快。几丁质管组和神经束膜缝合组再生神经与正常组比较,术后3月,其神经诱发电位潜伏期较长、动作电位波幅较低、神经-肌肉传导速度较慢,均为显著差异(P<0.01)。至术后5月,差异缩小,但仍有显著性(P<0.05)。同期内,几丁质管组和神经束膜缝合组再生神经相比较,差异无显著性(P>0.05)。实验结果提示:纤维蛋白胶联合几丁质管应用于面神经的修复具有简单、迅速、可靠的特点。

This animal experiment was aimed to apply fibrin in facial nerve repair and to quest for technical improvements in facial surgery. In each of 15 healthy large ear white rabbits, a unilateral 5 mm intratemporal facial nerve gap was created, the proximal and distal stumps were inserted into chitin tube, 1 ml autologous fibrin glue was applied around the anastomotic zone, and no suture was employed. At 3 months and 5 months after opertion, electrophysioligical study was performed. Compared with normal nerves, the regenerating nerves in both the chitin tube bridged group and the perineurium suture group had longer incubation period, lower amplitude, slower nerve-muscle conduction velocity at 3 months postoperatively. The differences were distinctly significant （P 〈0.01）. Although being decreased at 5 months after operation, the differences were still statistically significant （P〈0.05）. There were no significant differences between the chitin tube bridged group and perineurium suture group at 3 months and 5 months, respectively. The study suggests that facial nerve repair using fibrin glue and chitin tube has the advantages of being easier,faster and more stable.