周围神经断端桥接后数量放大效应的研究

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目的证实周围神经横截面不对等修复时神经纤维数量的放大效应。方法选用雄性 Sprague-Dawley 大鼠50只,分为 A、B、C、D、E 5组。A、B、C 3组将大鼠坐骨神经切断后,A 组近端保留完整断端与远端坐骨神经用甲壳质套管留置2mm 间隙套接,B 组在近端5 mm 处将坐骨神经中的腓总神经束结扎切断,将胫神经束与远端坐骨神经套接,C 组在近端5 mm 处将坐骨神经中的胫神经束结扎切断,将腓总神经神经束与远端坐骨神经套接;D、E 两组将胫神经在分叉处远端5 mm 组将胫神经切断;D 组结扎切断2/3近端纤维,将剩余神经纤维与远端胫神经进行甲壳质套管套接,E组将全部近端纤维与远端胫神经进行甲壳质套管套接。1、2、4、12周后分别取材进行组织学和电生理研究。结果采用 SPSS 软件进行统计学分析。结果 12周后电生理检查发现,各组诱发出的最大波幅下面积 B、C 两组小于 A 组(均 P<0.05),D 组小于 E 组(P<0.05)。A 组与 B、C 组之间,D、E 组之间感觉神经传导速度相近。锇酸染色有髓神经纤维计数:各组远端均大于近端:A 组远端比近端增加34.4%,B 组增加39.6%,C 组增加80.4%,D 组增加101.1%,E 组增加48.9%(P<0.05)。结论在周围神经桥接后,远端神经纤维数量明显大于近端,存在神经纤维数量的放大;同源的神经桥接的放大效应大于非同源的神经。临床上较细神经修复远端粗大神经是可能的。 Objective To confirm the magnifying effect of the number of nerve fibers in the repair of non-equivalent peripheral nerve cross-section. Methods Fifty male Sprague-Dawley rats were randomly divided into A, B, C, D and E 5 groups. Group A, B and C after the sciatic nerve was cut off, the complete proximal segment of group A and the distal sciatic nerve were sutured with a 2 mm gap in the chitin cannula. In group B, the proximal part of the sciatic nerve The total nerve bundle ligation cut, the tibial nerve bundle and the distal sciatic nerve socket, C group in the proximal 5 mm at the sciatic nerve tibial nerve bundle cut off, the common peroneal nerve bundle and the distal sciatic nerve socket; D, E group, the tibial nerve at the bifurcation distal 5 mm group cut the tibial nerve; D group ligation cut 2/3 proximal fibers, the remaining nerve fibers and the distal tibial nerve chitin sheath suture, E group All proximal fibers and distal tibial nerve were chitin sleeved. One, two, four, twelve weeks later, the specimens were harvested for histological and electrophysiological studies. Results SPSS software was used for statistical analysis. Results Electrophysiological examination at 12 weeks showed that the area under the maximal amplitude of each group was smaller than that of group A and group B (P <0.05), and group D was less than that of group E (P <0.05). A group and B, C group, between D, E group similar sensory nerve conduction velocity. Osteomyelin-stained myelinated nerve fibers: The distal end of each group was larger than the proximal end: the distal end of group A increased 34.4% than the proximal end, the group B increased 39.6%, the group C increased 80.4%, the group D increased 101.1% and the group E increased 48.9% (P <0.05). Conclusion After the peripheral nerve is bridged, the number of distal nerve fibers is obviously larger than that of the proximal ones, and there is an enlargement of the number of nerve fibers. The amplifying effect of homologous nerve bridging is larger than that of non-homologous nerves. Clinically, fine nerves to repair the distal coarse nerve is possible.
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