周围神经侧侧缝合法的实验研究

An experimental study of peripheral nerve regeneration after side-to-side neurorrhaphy

目的提出一种修复周围神经损伤的新方法——侧侧缝合法，并对侧侧缝合后神经的再生模式进行初步研究。方法选用 SD雄性大鼠 12只，双下肢随机分为实验侧和对照侧。实验侧 :将腓总神经在大腿下 1/3处切断，断端结扎后将其远端与相邻胫神经干适当松解后靠拢，纵行切开两神经相邻侧面的神经外膜、束膜长约 0.5 cm，至部分神经纤维外露。紧密对合两切开面后缝合束膜、外膜。对照侧 :腓总神经在相同部位切除 0.5 cm，将切除段神经倒置后原位移植行端端束膜、外膜缝合。 3个月后，对神经的再生情况进行肌电、组织学等检测。结果实验侧腓总神经远端有良好的神经再生，再生的神经纤维质量与对照侧自体神经移植相比差异无显著性意义 (P >0.05)；侧侧缝合口神经切片可见再生的轴突来自胫神经侧芽。结论周围神经侧侧缝合后可以再生。

Objective To describe a new method of side-to-side neurorrhaphy for the repair of peripheral nerve injury and study the nerve regeneration after this procedure. Methods Twenty SD rats were used, bilateral lower extremities of the animals as the operated specimens were randomly divided into experimental and control sides. In experimental side, the peroneal nerve was transected, the distal segment was kept close to neighboring tibial nerve at suitable site, and then the epineurium and perineurium of two neighboring segment were incised longitudinally for 0.5 cm to expose the nerve fibers. At last, the perineurium of two nerve was anastomosed by side-to-side neurorrhaphy. In control side, the peroneal nerve was resected for a length of 0.5 cm, and then the resected segment was reversely anastomosed with end-to-end neurorrhaphy. The nerve regeneration was analyzed with electromyographic and histological examination after 3 months. Results A large number of newly grown nerve fibers were found in the distal peroneal nerve of experimental side, the quality of the regenerated fibers exhibited no significant difference to nerve grafting side (P >0.05). Conclusion The injured peripheral nerve is able to regenerate after side-to-side neurorrhaphy.