壳聚糖神经导管联合PRP修复面神经缺损的实验研究

Experimental study of using chitosan nerve conduit combined with PRP to repair facial nerve defect

目的:利用壳聚糖制作可降解神经导管,探讨壳聚糖神经导管联合自体富血小板血浆(PRP)修复面神经缺损的可行性,为临床修复面神经缺损提供新方法。方法:新西兰大白兔40只,随机分4组,各10只。建立面神经上颊支缺损模型并置于神经再生导管中,分别注入等量的PRP和生理盐水。壳聚糖神经导管加PRP为A组、壳聚糖神经导管加生理盐水为B组、硅胶管加生理盐水为C组、硅胶管加PRP为D组。术后8周进行面神经大体观察、神经电生理检测、组织学观察、图像分析、评价神经再生恢复情况。结果:A、B组神经导管部分降解吸收,C、D组神经导管未降解,A、D组再生神经粗大而B、C组细小。电生理检测A、D组再生神经传导速度及波幅均优于B、C组(P<0.05),A、D组肌肉动作电位潜伏期低于B、C组(P<0.05),A组与D组再生神经传导速度、波幅及肌肉动作电位潜伏期差异无统计学意义(P>0.05)。图像分析有髓神经纤维数目及髓鞘厚度,A、D组优于B、C组(P<0.05),A组与D组比较差异无统计学意义(P>0.05)。结论:壳聚糖神经导管联合PRP可作为一种新的面神经缺损修复手段,其效果较好,有望应用于临床。

Objeetlve：The purpose of this study was to produce chitosan nerve conduit in order to investigate the feasibility of chitosan nerve conduit combined with autologous platelet-rich plasma （PRP） for repairing facial nerve defects. Method：Forty New Zealand white rabbits were randomly divided into four groups （n = 10 in each group）. Establishment of the facial nerve defect model of the upper buccal branches was placed in the nerve regeneration catheter and injected with the same amount of PRP and saline. The PRP was injected into the chitosan nerve conduit as group A. The physiological saline was injected into the chitosan nerve conduit as group B. The physiological saline was injected into the silicone tube as group C. The PRP was injected into the silicone tube as group D. Eight weeks later, facial nerve gross observation, facial nerve electrophysiological tests, histological observation,image analysis, valuation of nerve regeneration recovery were detected. Result.. After 8 weeks, the chitosan nerve conduit was partially degraded in group A and group B , and the nerve conduits of C and D groups were not degraded. The regenerative nerve in the catheter becomes thick in group A and D, and the smaller in group B and group C. Electrophysiological detection of group A and group D of regeneration of nerve conduction velocity and amplitude were better than those of group B and group C （P〈0.05）. The latency of muscle action potential in group A and group D was lower than group B and group C （P〈0.05）. There was no significant difference in the latency of regenerative nerve conduction velocity, amplitude and muscle action potential between group A and D （P〈0.05）. Image analysis of the number of myelinated fibers and the thickness of myelin in group A and group D berter than group B and group C （P〈0.05）. There was no significant difference in the number of myelinated fibers and the thickness of myelin between group A and group D （P〉0.05）. Conelusion：The chitosan nerve conduit combined with PRP has a certain effect on the repair of facial nerve defects and is expected to be applied to the repair of clinical facial nerve defects.