腓浅神经预变性桥接面神经和舌下神经治疗不完全性面瘫的实验研究

Hypoglossal -facial nerve neurorrhaphy with predegenerated sural nerve graft for incomplete facial palsy in rats

目的探讨改良的舌下神经一面神经端一侧吻合术修复不完全性面瘫的治疗效果。方法28只大鼠分为6组，A组：健康对照组，不做任何处理；B组：完全性面瘫组，完全离断面神经后不做任何处理；C组：不完全性面瘫组，损伤结扎面神经后不做任何处理；D组：不完全面瘫修复组，术后4个月离断神经移植物；E组：不完全面瘫修复组，术后4个月离断面神经近侧端。鼻尖偏离指数实验检测面容对称性；神经电生理检测肌动作电位；逆行示踪法检测舌下神经的再生；半薄切片观察髓鞘再生。结果鼻尖偏离指数实验检测q角度，D组比C组d角恢复明显（P〈0．01）；肌动作电位检测D组的峰面积值明显高于C组（P〈0．01）。半薄切片显示D组面神经远端内新生髓鞘的数量多于C组（P〈0．01）。逆行示踪显示，在修复术后4个月，D组大鼠的面神经核和舌下神经核中检测到（284±80）个和（83±48）个CTB—Alexa55标记的神经元。结论利用预变性腓浅神经移植物桥接舌下神经和面神经这个改良的吻合术修复不完全性面瘫，能够明显改善不完全损伤的面神经功能，有效治疗不完全性面瘫。

Objective For the treatment of persistent incomplete facial palsy, we investigated in rats a modified method using hypoglossal - facial nerve ＂side＂ - to - side neurorrhaphy with predegenerated nerve graft（PNG）. Methods 28 adult male Fisher 344 rats were grouped into A （intact）, B （complete facial palsy）, C （incomplete facial palsy ）, D （incomplete facial palsy repair- cut PNG） and E （incomplete facial palsy repair - cut facial nerve ）. The treatment was assessed by the angle ct analysis, electrophysiological examination, electron microscopy analysis and retrograde labeling. Results The group D was found a higher recovery of facial symmetry compared to group C （ P 〈 0. 01 ）. MAPs displayed significantly greater surface values in group D compared with group C （ P 〈 0. 01 ）. The analysis of semithin sections in distal facial nerve showed numerous regenerating myelinated axons （ P 〈0.01 ）. There were 83 -＋ 48 and 284 ＋_ 80 CTB Alexa 555 labeled neurons in group D, respectively, in the right hypoglossal and facial nuclei 4 months after bypoglossal -facial nerve neurorrhaphy. Conclusions This study demonstrated that hypoglossal - facial nerve ＂side＂ - to - side neurorrhaphy through a predegenerated nerve graft could lead to rapid functional benefits for persistent incomplete facial palsy.