比较不同膈神经移位术式重建屈肘功能的实验研究

Comparison of restoration of elbow flexion by different phrenic nerve transfer methods: an experimental study

目的 比较3种不同手术方式将膈神经移位至肌皮神经后屈肘功能恢复的疗效。方法取SD大鼠120只,随机分为开胸组,锁骨上组,移植组,对照组4组,每组30只大鼠。于术后1,2,3个月行大体观察,肌电检查和组织学检测。结果 开胸组于术后11-19 d,锁骨上组于术后12-21 d,移植组于术后17～28 d手术侧出现与呼吸同步的屈肘动作。经手术侧肱二头肌复合运动动作电位(CMAP)的潜伏期延迟率和最大波幅恢复率,肱二头肌的肌湿重恢复率,肱二头肌的肌纤维截面积恢复率,远端有髓神经纤维截面积,有髓神经纤维通过率等5项检测结果证实,开胸组均优于锁骨上膈神经移位组和神经移植桥接膈神经组(P<0.05)。结论 大鼠经胸取全长膈神经移位至肱二头肌手术方式的疗效优于另2种膈神经移位的手术方式。

Objective To compare the treatment outcome of 3 kinds of phrenic nerve transfer to musculocutaneous nerve for restoration of elbow flexion. Methods One hundred and twenty SD rats were divided into 4 groups randomly: open chest group, supraclavicular group, grafting group and control group, with 30 in each . The general observation, electrophysiological and histological examination were performed on 1,2 and 3 months respectively after the operation. Results Elbow flexion appeared at the same pace of respiration in the open chest group on days 11 - 19, in the supraclavicular group on days 12 - 21, while in the grafting group on days 17 - 28, postoperatively. The open chest group was superior to the other two phrenic nerve transfer groups in the latency delaying rate and amplitude recovery rate of compound muscle action potential( CMAP) , the recovery rate of wet muscle weight of biceps, the cross-sectional area of the regenerating myelinated fibers, and the passing rate of myelinated nerve. Conclusion The treatment outcome of transfer of phrenic nerve harvested from thoracic cavity is superior to that of the other 2 phrenic nerve transfer methods.