膈神经移位术后肱肌及肱肌肌支恢复的实验研究

Recovery of the brachialls muscle and brachialis branch of the musculocutaneous nerve after phrenic nerve transfer： an experimental study

目的观察两种膈神经移位术后肱肌及肱肌肌支功能恢复的情况，探讨修复后肱肌及肱肌肌支再利用的可能性。方法取SD大鼠48只，体质量150～200g，随机分为两组，膈神经通过移植神经移位至上干前股组（上干组），膈神经通过移植神经移位至肌皮神经组（移植组）。分别于术后1、2,3个月取材进行大体观察、神经电生理学及组织学检测。结果上千组于术后17～20d出现与呼吸同步的屈肘运动，移植组于术后20-25d出现与呼吸同步的屈肘运动。术后3个月切断肱肌肌支对两组大鼠的屈肘动作均无明显影响。两组肱肌复合肌肉运动电位最大波幅恢复率、肌湿重恢复率、肌纤维截面积恢复率于术后3个月差异均元统计学意义（P〉0．05），肱肌肌支再生有髓神经纤维通过率于术后3个月差异有统计学意义（P〈0．05），上千组优于移植组。结论两种膈神经移位术均可使肱肌及肱肌肌支得到恢复，肱肌的远期恢复程度在两组间差异无统计学意义，肱肌肌支的远期恢复上干组优于移植组。

Objective To observe and compare the recovery of the brachialis muscle and brachialis branch of the musculoeutaneons nerve after two phrenic nerve transfer methods, and discuss the possibility of musing braehialis muscle and brachialis branch of the musculocutaneous nerve for functional restoration. Methods Forty-eight SD rats, weighing 150 to 200 g, were randomized into two groups（with 24 each） ： phrenie nerve transfer to the anterior division of the upper track （ upper trunk group） and phrenic nerve transfer to the museuloeutaneous nerve （musculocutaneous group）. General observation, electrophysiological and histological examination were performed 1, 2 and 3 months after the surgery, respectively. Results Elbow flexion synchronized with respiration was observed 17 to 20 days postoperatively in the upper truck group. In the museulocutaneous group this movement was observed 20 to 25 days postoperatively. Transection of the brachialis branch 3 months after phrenic nerve transfer did not affect elbow flexion in both groups. Compound muscle action potential （CMAP） amplitude recovery rate, wet weight recovery rate and muscle fiber cross-sectional area recovery rate of the brachialis muscle were not significantly different between the two groups 3 months postoperatively（ P 〉 0.05）. There was significant difference between the two groups in the passing rate of regenerating myelinated nerve fibers 3 months postoperatively （ P 〈 0.05）, the upper truck group being superior to the musculocutaneous group. Conclusion Both phrenic nerve transfer methods can lead to recovery of the brachialis muscle and brachialis branch of the musculocutaneous nerve. Long-term recovery of the brachialis muscle is not different in two groups. However, the upper truck group has superior brachialis branch recovery.