鼠周围神经端侧缝合与侧侧缝合修复方式的比较研究

Comparative studies of peripheral nerve repair mode between end to side neurorrhaphy and side to side neurorrhaphy in rates

目的 进一步探讨神经缝合修复方式对神经再生的影响。 方法 将SD鼠分为两组。端 侧缝合组 :将腓神经远侧断端与去外膜胫神经 (开窗 )行端侧缝合 ,开窗大小相当于腓神经的直径。侧 侧缝合组 :将腓神经远侧断段侧壁去除外膜 ,同样胫神经侧壁去外膜 ,两者去除外膜的面积相当于腓神经直径的 3倍。将去外膜的两神经干进行侧 侧缝合。通过足印分析法 ,组织学方法 ,电生理 ,神经纤维密度等测量。比较两种修复法神经再生质量。 结果 术后 16周时端 侧组和侧 侧组腓神经功能指数分别为 (- 39 92± 11 6 7)和 ( 6 4 49± 31 31) (P =0 0 33) ,有显著差异。电生理术后 16周侧 侧组腓神经潜伏期 (Lat) (1 17± 0 2 6 )、波幅 (Amp) (2 4 9± 3 5 9)优于端 侧组Lat(1 42±0 0 6 )、Amp(16 5± 7 0 4)。组织学检查显示侧 侧组神经纤维密度 (4 330± 6 72 )较端 侧组 (3186± 199)高。 结论 鼠类腓 胫神经侧

Objective To study the impact of nerve repair mode on reinnervation. Methods SD rates were divided into two groups: end to side group and side to side group. In the first group, the distal ending was sutured to the lateral wall of tibial nerve with removal of the epineurial sheath. The area of removed sheath was same as that of peroneal nerve cross section. In the side to side group, the lateral side of distally severed peroneal nerve trunk with removal of the epineurium was sutured to the tibial nerve trunk with removal of the same area of the epineurium. The area of removed epineuium in this group was as three times as in the first group. By means of walking track analysis, histologic evaluation, electrophysiological test and the measurement of density of reinnervational nerve fibers, the quality of reinnervation was compared between the two kinds of neurorrhaphy. Results There was a significant difference between the two groups in peroneal function index (PFI) 16 weeks after operation. PFI in the end to side group was -39 92±11 67 and PFI in the side to side group was -64 49±31 31, P =0 033. Electrophysiological test showed that peroneal nerve latent period (Lat)(1 17±0 26) and wave amplitude (Amp)(24 9±3 59) in the side to side group were better than Lat (1 42±0 06) and Amp (16 5±7 04) in the end to side group. Histologically, the number of nerve fibers (4330±672) in the side to side group was more than that (3186±199) in the end to side group. Conclusion Peroneal tibial nerve neurorrhaphy by the mode of side to side is beneficial to peripheral nerve reinnervation.