自体神经外膜小间隙缝合联合神经碎片及VEGF修复坐骨神经损伤

Repair of sciatic nerve injury with autologous epineurium suture combined with nerve fragments and VEGF

目的:探讨自体神经外膜小间隙缝合联合神经碎片、血管内皮生长因子(vascular endothelial growth factor,VEGF)修复大鼠坐骨神经损伤的可行性及优越性。方法:将SD大鼠随机分为4组,每组10只。对照组大鼠坐骨神经切断后采用传统端端吻合,实验A组采用自体神经外膜小间隙桥接法缝合,实验B组在小间隙内加入神经碎片,实验C组在小间隙再生室加入神经碎片与VEGF。术后12周行神经电生理检测、腓肠肌湿重比检测、HE染色显微镜观察,病理图像分析有髓神经纤维计数、测量再生轴突直径和髓鞘厚度。结果:(1)坐骨神经传导速度比较,实验A组、实验B组、实验C组均高于对照组(P<0.05),实验C组分别高于实验A组和实验B组(P<0.05),实验C组高于实验B组(P<0.05),实验B组高于实验A组(P<0.05);(2)实验组腓肠肌湿重比优于对照组(P<0.05),实验C组与实验B组均优于实验A组(P<0.05);(3)组织学观察:各实验组再生神经纤维分布均匀、密集,对照组再生神经纤维较少、排列不规则。与对照组比较,实验A组、实验B组、实验C组有髓神经纤维计数、再生轴突直径、有髓神经纤维髓鞘厚度均升高(P<0.05);各指标两两比较,实验C组分别高于实验A组和实验B组(P<0.05),实验C组高于实验B组(P<0.05),实验B组高于实验A组(P<0.05)。结论:神经碎片联合VEGF可有效促进损伤神经再生及功能重建。

Objective：To investigate the feasibility and superiority of joint using small gap coaptation autologous epineurium suture,nerve fragments and VEGF in repairing damage of rat sciatic nerve. Methods： The SD rats were randomly divided into four groups,10 rats in each. The sciatic nerve was transected and directly repaired by end- to- end suture in control group. Pure small gap autologous epineurium coaptation suture was used in experimental group A; The nerve fragments were added to small gap autologous epineurium in experimental group B; The nerve fragments and VEGF were added to small gap autologous epineurium in experimental group C; Electroneurophysiological detection,wet- weight ratio of gastrocnemius and HE analysis under optical microscope were performed 12 weeks after operation. to count the number of nerve fiber and check regenerated axons diameter and myelin thickness. Results：1,The conductive speed of sciatic nerve： group C B A control group（ P〈0. 05）. 2,The wet- weight ratio of gastrocnemius： the gastrocnemius recovery in each experimental group was better than that in control group（ P〈0. 05） and the gastrocnemius recovery in group B and C were better than that in group A（ P〈0. 05）. 3,The histology and biopsy image analysis： all existed regenerating nerve fibers in each experimental group were evenly and densely distributed.; regenerating nerve fibers in control group were less and irregularly arranged. The number of spinal nerve fiber,regenerated axons diameter,myelin thickness in biospy image analysis showed： group C B A control group（ P〈0. 05）. Conclusions： The small gap coaptation autologous epineurium plus nerve fragments and VEGF greatly promotes nerve regeneration and functional recovery after damage.