预构血管化外周神经移植的实验研究

Experiment of Prefabricated Vascularized Nerve Graft in Rabbits

目的 :建立预构血管化外周神经移植的动物模型 ,探讨预构血管化神经移植对神经再生的影响。方法 :选用 42只大耳白兔 ,右耳中央动静脉血管束植入预构右面神经上颊支 ,右侧为实验组 ,5周后行带血管的神经移植 ,左侧为对照组行不带血管的神经移植 ,经血管墨汁灌注、神经电生理及变性髓鞘 Nauta染色组织学微细结构观察 ,检测预构血管化的神经移植对神经再生的影响作用。结果 :预构血管化的神经移植比不带血管的神经移植术后8周、10周神经传导速度快。实验组在术后 6、8、10周髓鞘厚度、神经纤维直径和 G值均优于对照组。结论 :预构血管化的神经通过微血管重建 ,在移植过程中保持了神经血液供应的连续性 ,有利于神经再生和功能的恢复。

Objective:This study was to show an effective technique for prefabrication of a vascularized nerve graft and to compare the results of a prefabricated vascularized nerve graft with a conventional nerve graft in a normal recipient bed. Methods:This experiment was carried out in 42 rabbits. The central vessel of the pinna were dissected and then placed into a subcutaneous flap pocket in the buccal branch of the facial nerve on right side(the experimental side). After 5 weeks, the vascularized nerve grafting of the facial nerve was created on right side, and the conventional nerve grafting was created on left side(the control side). Postoperative evaluation was performed with carbon ink perfusion, electrophysiological testing, and histological observation.Results:Nerve conduction velocity showed a superior value at the 8th and 10th week on the experimental side (P<0.05). The thickness of myelin sheath and diameter of the nerve fiber showed significant difference in nerve regeneration between the two sides (P<0.05).Conclusion:Full neovascularization was observed surrounding and within the nerve graft 5 weeks after the central vessel of the pinna were implanted into the facial nerve. The prefabricated vascularized nerve graft is superior to the conventional nerve graft for the nerve regeneration and the recovery of function.