直径相异的神经连接方法对神经再生的影响

Comparative study for the nerve repair of mismatched nerves and nerve regeneration

目的探索直径相异神经的连接方法与神经再生的关系。方法以大鼠臂丛根性撕脱伤为模型，将膈神经移位于外侧束（直径比为１∶４），采用干干、干束、包埋和端侧缝合及无间隙和小间隙静脉套接六种连接方法，术后用电生理学、组织学和功能测定评估神经再生和功能恢复情况。结果术后４个月时，各端端吻合组的各项观察指标优于端侧组；各端端吻合组间，除潜伏期和最大收缩持续时间恢复率无明显差异外，静套组的有髓神经纤维通过率优于干束组，其余各项指标显示静套组、干干组、包埋组优于干束组。结论端端吻合优于端侧吻合；干干对合优于干束对合；套接缝合优于直接缝合；

Objective To investgate the relationship between nerve repair of mismatched nerves and nerve regeneration. Methods The six different neurorrhaphies, trunk to trunk suture, trunk to fasciculus suture, embedded suture, end to side suture, non and little gap sleeve insertion through vein conduit, were used to transfer the phrenic nerve to the lateral cord in the rat model of brachial plexus root avulsion. Electrophysiological, histological examinations and functional evaluation were used to assess nerve regeneration and the functional recovery of the biceps brachii muscle postoperatively. Results At the fourth month after operaton, the end to end coaptation groups were superior to the end to side group in all parameters. Among the end to end coaptation groups, except that the delayed rates of latency and the maximal persistent time had no statistically significant differences, the myelinated axon conduits of the two vein conduit sleeve insertion groups were superior to that of trunk to fasci culus group. The other parameters indicated that the the vein conduit sleeve insertion groups, embedded group and trunk to trunk group had no significant statistical difference, but they were superior to the trunk to fasci group. Conclusion 1. The end to end coaptation is superior to the end to side coaptation. 2. The trunk to trunk coaptation is superior to the trunk to fasciculus coaptation. 3. The sleeve insertion is superior to direct suture. 4. The statisficul difference of non and little gap vein conduit sleeve insertion groups are not statistically significant(Shanghai Med J, 1999,22:143 146).