面神经吻合术手术时机探讨与再生神经纤维研究

Optimal Timing For Repair of Facial Nerve Trauma Study Of Regenerated Fibers

目的探讨面神经损伤后最佳修复时机。方法通过对面神经即时吻合和延迟不同时期吻合术后面神经有髓纤维通过率的计算,评价神经再生的效果。同时对再生有髓纤维的髓鞘形态进行电镜观察,计算髓鞘腔面积和髓鞘厚度,对照各组各阶段面神经功能恢复情况,客观评价面神经即时吻合和延迟不同时期吻合术后面神经再生的情况。结果面神经吻合术后2个月检测,正常组、即时缝合组和延迟7 d缝合组的有髓纤维通过率明显高于其他各延迟缝合组(P<0.05);即时缝合组和延迟7 d缝合组面神经吻合口远端的髓鞘形态与正常组接近;其他各延迟缝合组面神经吻合口远端的髓鞘形状较不规则,直径小,髓鞘厚度薄,延迟2个月组和延迟3个月组更为明显。结论延迟一段时间修补面神经同样可以得到较好的再生效果。通过对面神经吻合术最佳手术时机的研究,为临床实践提供了理论基础,具有一定临床实际意义。

Objective To evaluate the curative effect of immediate nerve suture and delayed nerve suture more comprehensively and more impersonally. Methods 64 guinea pigs were randomly assigned to one of the eight groups and the normal group： groups of immediate FFA, delayed FFA for 7 days, delayed FFA for 14 days , delayed FFA for 21 days , delayed FFA for one month, delayed FFA for 60 days , and delayed FFA for 3 months by turns. Results Two months after nerve suture, figured out the passing rate of myelinated fibers growing from the proximal stump to the distal stump. Observed the form of regenerated fibers under an electron microscope. Calculated the cavity area and the thickness of the regenerated myelin sheath with a computer image processing system. From the study, we can see that the passing rate of myelinated fibers of the group of immediate FFA and the group of delayed FFA for 7 days are significantly higher than that of other groups of delayed suture （ P 〈 0. 05 ） , whereas the passing rate of the groups of delayed suture for 2 months and 3 months are apparendy lower than that of the group of immediate FFA and other groups of delayed FFA. Under the electron microscope , the figure of regenerated fibers of the group of immediate FFA and the group of delayed FFA for 7 days is very similar with that of the normal myelinated fibers： the fibers are relatively thick, the cross sections of the fibers were ellipse shaped, and the myelin sheaths are thick. With the computer image processing system, we see that in the group of the delayed FFA for 7 days, the cavity area of the regenerated myelin sheaths is larger than that of the group of immediate FFA and other groups of delayed FFA. In the case of thickness of regenerated myelin sheaths, the group of immediate FFA and the group of delayed FFA for 7 days took the superiority to other groups of delayed FFA, and these two groups showed no difference with the normal group. Conelution From all kinds of criteria taken from the regenerated myehnated fibers, the curative effect of the group of delayed FFA for 7 days is as good as that of the immediately sutured group. The curative effect is poor if repair the facial nerve 2 ~ 3 months after the trauma.