不同端侧缝合方法对周围神经再生的影响

The effect of different end to side coaptation on peripheral nerve regeneration

目的比较各种不同的端侧缝合方法治疗周围神经损伤后神经再生的优劣。方法ＳＤ大鼠９０只，随机分成５组。前４组右侧腓总神经作端侧缝合，左侧切除长１．５ｃｍ的腓总神经作为对照。Ａ组：右侧远断端与近段行侧端吻合，外膜不开窗。Ｂ组：方法同Ａ组，但束、外膜开窗。Ｃ组：右侧近断端与远段行端侧吻合，外膜不开窗。Ｄ组：方法同Ｃ组，但束、外膜开窗。Ｅ组：右侧以４５度角、左侧以９０度角作侧端缝合。各组分别于术后１、２、３个月取材，作肌电图、组织学及肌湿重检查。结果Ａ与Ｂ，Ｃ与Ｄ组比较，运动神经诱发电位潜伏期、波幅及有髓纤维计数，后者优于前者（Ｐ＜０．０５）。肌湿重及肌纤维截面积，两者无明显差异（Ｐ＞０．０５）。４５度与９０度角比较，前者神经再生质量明显优于后者（Ｐ＜０．０５）。结论周围神经可通过端侧吻合而再生，以束。

Objective To study and compare the effect of different end to side coaptation on peripheral nerve regeneration. Methods 90 SD rats were randomized into 5 groups. In group A,B,C and D, the right peroneal nerve was transected and sutured in an end to side fashion, while a 1.5 cm segment was cut off on the left peroneal nerve to serve as control. The distal end of the right peroneal nerve was sutured to the side of the proximal stump with no perineurial window in group A, but through epineurial and perineurial window in group B. The proximal end of the right peroneal nerve was sutured to the side of the distal stump with no perineurial window in group C, but through epineurial and perineurial window in group D. In group E, end to side coaptation was made in an angle of 90 degrees on the left peroneal nerve and 45 degrees on the right. Electromyographic, histological and muscle wet weight analysis were performed 1, 2 and 3 months postoperatively. Results The latency, amplitude of compound muscle action potential and count of myelinated nerve fibers were better in group B than in group A, and also better in group D than in group C ( P <0.05). The muscle wet weight and cross sectional area of the myofibers had no significant difference between group A and B , or group C and D. In group E, the quality of regenerating nerve fibers on the right side was superior to that on the left side ( P <0.05). Conclusion Peripheral nerve could regenerate after end to side coaptation. It showed best regeneration when suturing through epineurial and perineurial window in 45 degrees.