显微修复肌内神经对断裂股直肌恢复的作用

The role of Intramuscular nerve microsurgical repair in the recovery of laclacerated musculus rectus femoris

目的:探讨显微修复肌内神经对损伤骨骼肌恢复的影响。方法:30只新西兰大白兔随机分为A、B2组。2组均选取实验动物右侧股直肌作为实验侧,左侧股直肌作为空白对照侧。A组切断一侧股直肌后修复肌肉残端及肌内神经,B组仅修复肌肉。术后28周,测量股直肌湿重及力量,通过HE染色、Masson三色染色、肌球蛋白三磷酸腺苷酶(mATPase)染色及还原型辅酶Ⅰ四唑氮还原酶(NADH-TR)染色观测股直肌的形态学指标,通过t检验、ANOVA分析比较A、B2组自身及组间在各指标上的差异情况,从而判断显微修复肌内神经对损伤骨骼肌恢复的影响效果。结果:术后28周,与对照侧相比,肌内神经断伤组实验侧股直肌湿重、等长收缩力下降(P<0.05),Ⅰ型、Ⅱa型、Ⅱb型肌纤维横断面面积均恢复较差(P<0.05),肌肉萎缩、脂肪浸润及纤维变性明显,肌纤维再生状况欠佳,肌纤维直径变异较大。肌内神经修复组除Ⅱb型肌纤维恢复较差(P<0.05),其余各项指标基本恢复正常。结论:通过显微技术修复肌内神经,能够促进损伤骨骼肌的肌纤维再生,减轻肌肉萎缩及纤维变性,恢复肌纤维的正常形态及组成方式,促进损伤骨骼肌的恢复。

Objective：To explore the intramuscular nerve effect on the recovery of lacerated muscle. Methods：thirty （30） healthy New Zealand rabbits were involved in the study and randomly divided into groups A and B.The right musculus rectus femoris of the animal was chosen as the lacerated skeletal muscle model with the contralateral muscle as sham control. Group A underwent muscle laceration with the intramuscular nerve microsurgical repaired and muscle repaired;group B only with muscle repaired. After a postoperative period of 28weeks,measured the muscle wet weight and the muscle strength of musculus rectus femoris by electrical stimulation test and observed the change of morphology by Hematoxyline/eosin stain,Masson stain,NADH-TR stain and mATPase stain. Compared the difference of two groups through t-test and ANOVA to decide the effects of intramuscular nerve effect on muscle injury and repair. Results：At 28 weeks postoperative,Compared with the controls,wet weight and isometric contraction of musculus rectus femoris reduced in the intramuscular neurotmesis group （P〈0.05）,Group B was poorly recovered（P〈 0.05）in Cross-sectional area of type Ⅰ,Ⅱa and Ⅱb,and showed significant muscle atrophy,adipose infiltration, fibrosis,and few regenerating muscle fibers compared to the contralateral muscle. Compared with the controls in the group of the intramuscular nerve microsurgical repaired,cross-sectional area of type Ⅱ b was not good （P 〈0.05）. The other was mostly well recovered .Conclusion：Intramuscular nerve could promote muscle fiber regeneration of lacerated muscle,lighten muscle atrophy and fibrosis,and restore the muscle morphous and construction of muscle fiber type,thus resulting in better functional recovery.