端侧吻合与自体神经移植神经再生的比较研究

The comparison of peripheral nerve regeneration after terminolateral neurorrhaphy and autogenous nerve graft:an experimental study

目的比较周围神经端侧吻合与自体神经移植后神经再生的效果,为临床提供实验依据。方法选用Wister大白鼠60只,随机分成3组。A组:切断左侧腓神经1cm,造成神经缺损,取对侧相应的腓神经桥接缺损。B组:切断左侧腓神经,在邻近的胫神经干外膜上开一1mm小窗,将腓神经远端吻合到胫神经干侧方开窗处。C组:方法同B组,但束膜开窗。各组分别于术后8、12周取材并进行大体、组织学、形态定量学和电生理检测。结果自体神经移植体修复神经缺损后,再生神经的数目、有髓神经纤维截面积、运动神经传导速度均优于端侧吻合的外膜、束膜开窗组(P<0.05);外膜开窗组与束膜开窗组之间无显著性差异(P>0.05)。结论自体神经移植修复大鼠周围神经缺损,其再生神经纤维质量优于端侧吻合法。

Objective To compare the effect of end to side neurorrhaphy with autogenous nerve graft on peripheral nerve regeneration to provide theoretical foundation for clinical application.Methods 60 adult wister rats were randomly divided into 3 groups.In group A,A 1cm segment of the left peroneal nerve was removed,the defect was repaired with a segment taken from the contralateral peroneal nerve.In GroupB,theleft peroneal nerve was transected,then an 1mm epineural window was created on the neighbouring tibial nerve.The distal end of peroneal nerve was sutured to the windowed tibial nerve by means of end to side attachment.In group C,nerve TLN was performed as in group B except that the tibial perineurium at the suture site was removed(windowing) Histological, morphological and electrophysiological examinations were per formed 8 and 12 weeks after the operation.Results The cross area of myelinated nerve fibres,axon numbers,motor nerve conduction velocity were significantly better in group A than in group B or C(P< 0.05).There was no significant difference between B and C.Conclusion The quality of regeneration nerve fibres through autogenous nerve graft to repair nerve defect superior to that through terminolateral neurorrhaphy.