自体神经外膜小间隙桥接法构建神经再生室修复周围神经断裂的实验研究

The experimental study on repair of peripheral nerve rapture using a nerve regeneration chamber created by autologous epineurimn small gap coaptalion

目的 探讨应用自体神经外膜小间隙桥接法构建神经再生室修复周围神经断裂的可行性和优越性.方法 取SD大鼠40只,体质量250～350g,随机分成2组,每组20只.实验组：坐骨神经切断后采用自体神经外膜小间隙桥接法缝合；对照组：坐骨神经切断后采用神经外膜原位缝合.术后2、4、6、8、10、12、14及16周时,分别从2组中各取出2只大鼠,大体观察实验动物肢体恢复自主活动的时间,显微镜视下观察神经再生室及缝合口的大体形态,光镜及电镜下对2组再生神经纤维进行观察.结果 实验组大鼠恢复肢体自主活动快,缝合口与周围组织粘连轻.形态学观察发现小间隙神经纤维排列有序,结缔组织增生明显减少.电镜观察显示神经间隙远端再生神经髓鞘板层呈同心圆状排列致密、整齐,雪旺细胞增生明显.而对照组没有上述改变.结论 自体神经外膜小间隙桥接法构建神经再生室修复周围神经断裂是可行的,优于神经外膜原位缝合法,是修复周围神经断裂的一种新方法.

Objective To investigate the feasibility and superiority of a nerve regeneration chamber createded by autologous epineurium small gap coaptation in repairing peripheral nerve rupture.Methods A total of 40 Sprague Dawley（SD）rats weighing 250 to 350 g were randomly divided into two groups with 20 rats each.In the experimental group,the sciatic nerve was transected and repaired by autologous epineurium small gap coaptation.In control group,the sciatic nerve was transected and repaired by epineurium neurorrhaphy.At postoperative 2,4,6,8,10,12,14 and 16 weeks,2 SD rats from each group were deeply anesthetized for observation of autonomic activities,the appearance of the regeneration chamber and coaptation sites under the surgical microscope.The structural changes of the sciatic nerve were observed under microscope and transmission electron microscopy.Results The experimental rats recovered autonomic activities sooner.There were minimal adhesions at the outer surface of the epineurial tube to the surrounding tissue.The morphologic changes of the sciatic nerve showed connective tissue hyperplasia was significantly reduced in the small gap group,and the nerve fibers were more orderly arranged.Transmission electron microscope showed that the layers of myelin sheath were arranged compactly and regularly in concentric circles,and Schwann cell hyperplasia was obvious in the small gap group.No such changes were observed in the control group.Conclusion The nerve regeneration chamber created by autologous epineurium small gap coaptation in repairing peripheral nerve rupture is feasible and superior to in situ epineurium neurorrhaphy.This can be a new method to repair nerve ruptures.