医用OB胶联合几丁聚糖—胶原导管修复兔面神经损伤的实验研究

Facial nerve repair with OB glue and chitosan-collagen conduit:An experimental study in rabbits

目的:探讨医用OB胶联合几丁聚糖—胶原导管修复兔面神经损伤的效果。方法:30只健康中国大耳白兔随机分为3组,分别为显微外科吻合组(Ⅰ组)、医用OB胶黏合组(Ⅱ组)和医用OB胶几丁聚糖—胶原导管黏合组(Ⅲ组)。手术制作兔右侧面神经下颊支损伤模型,分别采用显微外科吻合、医用OB胶黏合以及在几丁聚糖—胶原导管内OB胶黏合技术进行修复。术后16周进行大体观察、神经电生理检测、组织学观察、图像分析,采用SPSS 17.0软件包对各组数据进行方差分析,评价神经再生恢复情况。结果:16周时,肉眼观察3组吻合口处均见神经再生,可抵抗一定拉力,几丁聚糖—胶原导管吸收明显,能抑制吻合口周围纤维结缔组织形成,Ⅰ组和Ⅱ组再生神经周围软组织黏连较Ⅲ组严重;3组神经肌肉功能恢复良好,口轮匝肌动作电位潜伏期无显著差异(P>0.05),但Ⅲ组的复合神经肌肉动作电位振幅(M波)显著高于Ⅱ组(P<0.05),其余两两比较均无显著差异(P>0.05);组织学观察,3组均可见不同程度纤维结缔组织、新生毛细血管增生及炎性细胞浸润,无论是光学低倍镜还是Gomori银染色高倍镜观察,Ⅲ组的几丁聚糖—胶原导管作用明显;图像分析结果提示,3组轴突再生率不同(P<0.05),Ⅱ组、Ⅲ组均高于Ⅰ组,其中Ⅱ组显著高于Ⅰ组且差异显著(P<0.01);再生轴突恢复比不同(P<0.05),Ⅰ组显著高于Ⅱ组(P<0.05),其余两两比较无显著差异(P>0.05)。结论:几丁聚糖—胶原导管生物相容性良好,与医用OB胶联合应用修复兔面神经损伤操作简便、效果肯定。

PORPUSE： To explore the effect of using OB glue combined with chitosan-collagen conduit to repair rabbit facial nerve injury.METHODS： Thirty Chinese rabbits were divided into 3 groups randomly.The injury in right facial nerve of rabbits was repaired using： nerve autografts（groupⅠ）,OB glue（groupⅡ）,and OB glue with chitosan-collagen conduit（groupⅢ） in 3 groups,respectively.Gross observation,electrophysiological study,histological study and image analysis were performed 16 weeks postoperatively.The data was subjected to one-way ANOVA with SPSS 17.0 software package to evaluate nerve regeneration.RESULTS： Nerve regeneration was obvious observed 16 weeks postoperatively and could resist certain tension.Chitosan-collagen conduit was degraded 16 weeks postoperatively and restrained the formation of neuroma.The tissue adhesions in groupⅠ and group Ⅱ was more severe than in group Ⅲ.The recovery of neuro-muscular function was good in 3 groups,and motor nerve action potential was not significantly different among 3 groups（P0.05）,but the compound muscle action potential（CMAP） of regenerated nerve was significantly higher in group Ⅲ than in group Ⅱ（P0.05）,there was no significant difference in other groups（P0.05）.Different degree of hyperplasia of fibrous connective tissue and new formed capillaries was noted,and inflammatory cell infiltration was also found in 3 groups.The effect of chitosan-collagen conduit in group Ⅲ was observed both under low magnification of microscope and high magnification with Gomori＇s silver staining.The recovery rate of myelinated fiber cross section diameter in 3 groups was different（P0.05）,significantly higher in group Ⅱand group Ⅲ than in group Ⅰ（P0.05）,and was significant difference existed between groupⅡand groupⅠ（P0.01）.The cross rate of myelinated fiber of the three groups was different（P0.05）,significantly higher in group Ⅰthan in groupⅡ（P0.05）,but no significant difference was noted in other groups（P0.05）.CONCLUSION： Chitosan-collagen conduit has excellent biocompatibility.It can be OB glue to repair nerves injuries with good results.