三种不同神经残端处理方式对神经瘤形成的影响

Effect of three nerve stump treatment methods on neuroma formation

[目的]观察单纯切断、肌内移植及残端焦化三种神经残端处理方式对神经瘤形成的影响。[方法]将48只成年新西兰大白兔随机分为3组,分别行坐骨神经单纯切断、肌内移植、残端焦化处理,于术后2、4、6、8周各取大白兔4只,观察一般情况、血液中NGF含量及神经残端形态学改变。[结果]各组动物术后伤口无感染,各实验组动物手术侧肢体均出现肌萎缩、趾骨外露及自残形为,但残端焦化及肌内移植组出现上述异常的程度比单纯锐刀切断组轻;随着观察时间的延长,锐刀切断组血清中NGF含量增加且保持较高水平,而神经残端焦化组和肌内移植骨骼肌包埋组含量渐下量,且神经残端焦化组下降更明显,差异有统计学意义。此外,与锐刀切断组相比,神经残端焦化组及神经肌内移植组神经残端内无髓神经纤维及细的有髓神经纤维明显减少,神经纤维再生不活跃。[结论]神经残端高频电刀焦化处理操作简单、安全,能有效预防神经瘤的形成,可能为痛性神经瘤患者带来全新的治疗理念。

ObjecUveJ To investigate the eiiect of three nerve stump treatment methods： simple cutting, intramuscular transplantation,and nerve stump coking-on neuroma formation. [ Method Forty-eight adult New Zealand rabbits were divided into 3 groups ： simple cutting of the sciatic nerve, intramuscular transplantation, and nerve stump coking. The general condition of the animals, NGF level in blood, and changes in the morphology of the nerve stump were observed 2,4,6, and 8 weeks after op- eration. [ Result] None of the animals showed wound infection. Muscle atrophy on the operated side, exposed phalanges, and self- mutilation were observed in each experimental group. The changes in the simple cutting group were more serious than those in the remaining groups. On extension of observation time, the NGF levels in blood in the simple cutting group were found to in- crease in a time-dependent manner;however, the other experimental groups, especially the nerve stump coking group, displayed a contrasting trend. This difference was statistically significant. In addition, compared with the sharp knife cutting group, the num- ber of unmyelinated and myelinated nerve fibers was significantly reduced in the remaining groups, and nerve fiber regeneration was not active. [ Conclusion] Nerve stump coking using a high frequency electro scalpel is simple and safe and could effectively prevent neuroma formation. These results could provide a theoretical basis for clinical application and might contribute to the de- velopment of a novel treatment for patients with painful neuroma.