神经端侧缝合术效果的研究

Evaluation of end-to-side neurorrhaphy

目的 :系统评价神经端侧缝合术的修复效果 ,为临床应用提供理论依据。方法 :10只SD大鼠 ,分为A、B两组 ,A组 :切断右侧腓总神经 ,将远侧断端以端侧缝合方式吻合到同侧胫神经外膜开窗部 ;B组 :切断右侧腓总神经 ,并将两断端分离 ,术后 1.5月作足迹分析、组织学及电镜检查。结果 :腓总神经指数达到 -4 1.63 4,新生轴突密度 5 1.43 7± 12 .0 41个 /10 0 0 μm2 ,突触素达正常的 40 %～ 60 %。结论 :神经端侧缝合术后 ,可诱导健康神经发出大量侧支 ,到达受体靶肌肉 ,并与之建立新的神经肌肉接头 ,从而部分恢复靶肌肉功能。神经端侧缝合术可通过供体神经的代偿作用 ,部分地恢复受体神经及靶肌肉功能 。

Objective:To evaluate functional recovery of nerve and muscle after end-to-side neurorrhaphy.Methods:10 SD rats were randomly and evenly devided into group A and group B.Right common peroneal nerve was amputated in all the rats.Then the distal stump was sutured to the ipsilateral tibial nerve by the end-to-side way through a epineurial window in group A. The right common peroneal nerve was severed in group B as denervated control.After 1.5 months all the rats were subjected to walking track analysis,histological and ultrastructure observation.Results:In group A peroneal nerve index (PFI) achieved -41.634,density of collateral axons 51.437±12.041/1 000 μm 2,synapsin (SYP) 439±120.5.In group B PFI was -100,SYP 0. In normal control PFI was 0, density of collateral axons 18.847±1.078/1 000 μm 2,SYP 842±84.7.Conclusion:End-to-side neurorrhaphy may induce nerve sprout plenty of collateral axons.The axons can reach target muscle to reconstruct functional neuromuscular junction,and recover the function of the muscle in some degree.