不同对位情况下神经直接缝合与小间隙套管法修复的疗效比较

Comparison of suture and conduit nerve repair in different alignment situation

目的比较不同对位情况下神经直接缝合与小间隙套管修复神经的疗效。方法取ＳＤ大鼠４０只，解剖并分离出右侧坐骨神经后于股中部切断，随机分为４组，每组１０只。Ａ组：行神经原位直接缝合；Ｂ组：将神经远端旋转１８０度后直接缝合；Ｃ组：用硅胶管套接原位修复神经，神经间隙为５ｍｍ；Ｄ组：神经远端旋转１８０度后用硅胶管套接修复，神经间隙为５ｍｍ。术后４、８、１２周检测坐骨神经功能指数（ＳＦＩ），神经电图和组织形态学变化。结果Ｂ组ＳＦＩ、运动神经传导速度（ＭＮＣＶ）比Ａ、Ｃ、Ｄ三组恢复均差（Ｐ＜０．０１），Ａ、Ｃ、Ｄ三组间无明显差异（Ｐ＞０．０５）。再生有髓纤维计数各组间无明显差异（Ｐ＞０．０５）。结论神经断端对位正确时，无论是直接缝合还是用小间隙套管法修复，两者疗效一致；神经断端错位对合时，小间隙套管法修复的疗效优于神经直接缝合。

Objective To study the effect of suture and conduit nerve repair in different alignment situation. Methods 40 SD rats were divided into 4 groups, with 10 in each. The right sciatic nerves were transected at the mid level of the thigh. The nerves were then repaired in the following manner:(1)Group A: direct end to end suture;(2) Group B:direct end to end suture after 180° rotation of the distal stump;(3) Group C: conduit nerve repair with a 5 mm gap formed by a silicone tube; (4) Group D: conduit nerve repair after 180° rotation of the distal stump. Sciatic function index(SFI),electrophy siological and histomorphologic studies done at 4,8 and 12 weeks postoperatively. Results The SFI and motor nerve conduction velocity(MNCV) of group B were significantly lower than the other groups ( P >0.01). There is no statistically significant difference in group A、C and D ( P >0.05). Conlusions In correctly aligned situation, the result of nerve regeneratuon of direct suture was comparable to that of conduit nerve repair. In incorrectly aligned situation, conduit nerve repair was superior to direct suture.