神经端侧缝合与带血供的自体神经游离移植修复神经缺损的比较研究

A comparative study on repair of peripheral nerve defects by end-to-side anastomosis and free nerve autograft with blood supply

目的通过神经端侧缝合与带血供的自体神经游离移植的对比观察，分析神经端侧缝合的修复效果。方法选用SD大鼠20只，每只大鼠随机选择一侧下肢行神经端侧缝合，另一侧下肢建立带血运的神经游离移植模型。术后分笼饲养，观察肢体瘫痪及感觉恢复情况。术后6个月取缝合处以远腓总神经段标本切半薄切片，分别做甲胺蓝、变色酸2R-亮绿髓鞘染色和HE染色，测量神经横切面轴突数目、密度、直径等。超薄切片做透射电镜观察，测髓鞘厚度和有髓神经纤维面积。结果所有大鼠伤口一期愈合，足部无溃疡形成，外观红润饱满。于术后3个月左右胫前肌肌力恢复，趾展反射出现。光镜检查见两种手术方式均有有髓神经纤维生长，再生纤维排列整齐密集，呈线形平行排列。电镜观察见髓鞘形态正常。两种术式轴突数目、密度、直径、髓鞘厚度差异均无统计学意义（P〉0．05）。结论神经端侧缝合后有有髓神经纤维生长，修复效果与带血供的自体神经游离移植无显著性差异。

Objective To study the effect of end-to-side anastomosis in repair of peripheral nerve defects in comparison of that of free nerve autograft with blood supply. Methods Models of free nerve autograft with blood supply were established at one random hindlimb in 20 adult Sprague-Dawley rats and models of end-to-side anastomosis at the other one. The paralysis and sensation recovery of hindlimbs were observed after operation. Animals were sacrificed 6 months after operation. Methylamine staining, chromotropic acid-2R light green staining in myelin sheath and HE staining were used to measure the number, density and diameter of axons on the semithin sections of distal fibular nerve. Transmission electron microscope （TEM） was used to observe the thickness of myelin sheath and the area of medullated nerve fibers on the ultrathin sections. Results The operative wounds healed at one stage in all rats. Contraction of anterior tibial muscles and toe abduct reflection recovered 3 months postoperatively. Light microscope showed that medullated nerve fibers grew intensively and regularly in both models. The morphology of medullary sheath was normal under TEM. There was no significant difference in the number, density, diameter of axons or in the thickness of medullary sheath between the two operations（ P 〉 0. 05） . Conclusion In the effect on generation of medullated nerve fibers, there is no significant difference between end-to-side anastomosis and free nerve autograft with blood supply.