神经碎片联合NGF在自体神经外膜小间隙修复周围神经损伤

Nerve Fragments Combined with NGF Repair Peripheral Nerve Injury in the Small Gap of Autologous Nerve Sheath

目的研究神经碎片联合神经生长因子在自体神经外膜小间隙桥接法中修复周围神经损伤中的作用。方法 SD大鼠150只,体重200~250 g,随机分成5组,每组30只。对照组:传统端端吻合法缝合;单纯自体神经外膜小间隙组:自体神经外膜小间隙桥接法缝合;神经碎片组:小间隙中加入神经碎片;神经生长因子(Nerve Growth Factor NGF)组:小间隙中加入NGF;神经碎片联合NGF组:小间隙中加入神经碎片和NGF。术后4,6,8周,各组随机选取2只大鼠,观察肢体自主活动、足底溃疡愈合情况和神经断端吻合处形态。术后8周,各组随机抽取8只大鼠,进行组织学观察和神经电生理检测。结果实验组大鼠开始自主活动,足底溃疡开始愈合时间早;实验组神经生长良好,小间隙外膜仍然保持完整,无神经瘤形成,无明显塌陷破裂,可见到均匀分布的再生神经纤维,神经纤维数目和神经传导速度有差异。结论自体神经外膜小间隙桥接法修复周围神经损伤要优于传统神经外膜吻合法。在自体神经外膜小间隙加入神经碎片和NGF对周围神经的修复有显著促进作用,神经碎片与NGF的联合效果要明显优于单独使用。

Objective To study the role of the nerve debris and nerve growth factor in repair of peripheral nerve inju- ry by autologous nerve membrane small gap. Methods SD 150 big rats weighted 200 -250g and divide into 5 groups with 30 rats in each group. Control Group： traditional end to end anastomosis suture; nerve fragment group： add nerve fragment in small gap; nerve growth factor （NGF） group： add NGF in small gap; nerve fragment combining NGF group： add nerve fragment and NGF in small gap. In the 4th, 6th and 8th week after operation, select 2 big rats at random in each group and observe body autonomous activities, plantar ulcer healing situation and morphology of nerve end anasto- mosis. In the 8th week after operation, select 8 big rats at random in each group and make histological observation and nerve electrophysiological examination. Results Big rats of experimental group start autonomic activities and healing time of pantar ulcers starts earlier; nerve groups better in experimental group, small gap outer membrane keeps complete, no neuroma formed, no obvious collapse and rupture. Conclusions Adding nerve fragment and NGF in the small gap of autologous nerve outer membrane has obvious promotion effect and the effect of nerve fragment combining NGF is obviously better than independent use.