小间隙吻合术结合控释生长因子促进坐骨神经再生的实验研究

Control release of growth factors combined with small gap anastomosis promotes sciatic nerve regeneration after transaction in rats

目的探讨小间隙吻合术结合控释生长因子对大鼠坐骨神经损伤的修复作用。方法sD大鼠27只随机分为A、B、C三组，每组9只。建立大鼠坐骨神经横断模型；A组：以含有神经生长因子与碱性成纤维生长因子凝胶的硅胶管桥接神经远近端（间隙3ram）；B组：以含有生理盐水的硅胶管桥接神经远近端（间隙3mm）：C组：采用神经远近端直接缝合。术后8周进行坐骨神经指数（SFI）、神经电生理、肌肉湿重比检查以及组织学和免疫组化观察。结果从数据上看，A组在SFI、神经传导速度、肌肉湿重比、再生神经纤维密度及髓鞘化等方面均高于B组和C组，但三组的SFI、肌肉湿重比及新生轴突直径和髓鞘厚度均差异无统计学意义（P〉0．05）。A组与B组的神经传导速度差异无统计学意义（P〉0．05），两组均明显高于C组（P〈0．05）。再生神经纤维密度，三组间差异有统计学意义（P〈0．05）。结论小间隙导管吻合术可为大鼠坐骨神经再生提供一个良好的微环境，小间隙吻合术结合控释生长因子对神经再生有明显的促进作用。

Objective The nerve regeneration after peripheral nerve injury is slow and the degree of functional recovery is limited followed by a higher disability rate. How to accelerate the rate of nerve regeneration and improve the degree of nerve repair is a clinical challenge. This study aimed to investigate the role and the mechanism of growth factors gel combined with small gap nerve anastomosis in the regeneration of sciatic nerve injury in rats by nerve growth factor （NGF） and basic fibroblast growth factor （bFGF） gel injecting into silicon chamber which bridged the transection of nerve. Methods A total of twenty seven SD rats were chosen randomly, with a sharp blade to cut off the right hind leg sciatic nerve. Group A with silicon tube containing NGF and bFGF gel to bridge the nerve proximal and distal ends （ gap 3 mm）, Group B with silicon tube containing saline to bridge the nerve proximal and distal ends （gap 3 mm）, Group C with the direct suture of the nerve proximal and distal ends. Eight weeks after surgery, the sciatic nerve function index, neural electrophysiology, muscle wet weight and histological, immunohistochemical were observed. Results The sciatic nerve function index, nerve conduction velocity and muscle wet welght, the density of nerve fiber regeneration, myelinization in group A were better than those in group B and C （ P 〈 O. 05 ）. Conclusions Small gap nerve anastomosis method can provide a good regeneration microenvironment for the rat sciatic nerve regeneration, and the combined strategy of growth factor gel with small gap nerve anastomosis appears to have more positive effect on nerve repair.