惰性微孔聚四氟乙烯引导神经再生的远期效果

Long-term assessment of nerve repair with an inert microporous polytetrafluoroethylene chamber

采用微孔聚四氟乙烯（PTFE）管引导大鼠坐骨神经再生模型，综合评价该技术的远期效果．方法：36只Wistar大鼠随机分为2组，切断右侧坐骨神经：①对照组（n一18）：采用经典的外膜缝合法修复；②PTFE实验组（n一18）：以直径 2 mm PTFE管套接修复．术后 6及 9 mo进行电生理学检查、测量胖肠肌重量恢复率（GWR）、观察再生神经形态并行图像分析．结果：术后 6 mo，PTFE管内再生神经粗细均匀，无沙漏状改变；对照组神经传导速度（NCV）恢复率6O． 86％， PTFE组 54 36％（P＞ O． OS）；对照组 GWR为SO．89％，PTFE组 46． 11％（P＞O．OS）．术后 9 mo，对照组NCV恢复率65 99％，试验组58 79％（P＞O．OS）；对照组GWR为52．56％，试验组47 89％（P＞o．o5）．再生神经纤维形态正常，无受压征象．结论：综合以上结果和图像分析，认为PTFE修复神经后，再生纤维可以在免受压迫、有利神经营养、神经趋化因子发挥作用的微环境下逐渐成熟，其形态、功能等特性不逊于经典的外膜修复法．

AIM: To evaluate the long-term outcome of poly-tetrafluoroethylene (PTFE) chamber repair and to providemore evidence for its potential application in achieving a satis-factory functional recovery in clinical settings. METHODS:36 Wistar rats with transected right sciatic nerve were re-paired either by a conventional microsuture technique (n =18) or with a PTFE chamber, leaving a gap of 5 mm betweenthe nerve stumps (n = 18). RESULTS: 6 months after theoperation, the nerve conduction velocity recovered to6O. 86% and 54. 36% (P > O. O5), and the gastrocnemiusmuscle weight recovered to 5O. 89M and 46- 1l % (P>O. O5)respectively in the conventional and the PTFE chambergroups. Similarly, by 9 months, the recovery rate was65. 99% and 58. 79% for NCV recovery (P > O. O5), and52. 56 % and 47. 89 % for gastrocnemius muscle weight recov-ery (P>O. O5) respectively. Regenerating nerve fibers in thePTFE group had a regular round shape with no fragmenta-tion, wrinkling and splitting of the myelin sheath. Imageanalysis revealed that the ratio of the myelin to the total fiberby 9 months was bigger than that by 6 months in both groups(P>0. 01)- CONCLUSION: Microporous PTFE chamber re-pair can be used as an alternative, allowing for guided nerveregeneration and functional recovery, with no obvious long-term adverse effects.