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目的观察大鼠移植神经远侧吻合口再通术后脊髓前角细胞形态及功能变化,为长段神经移植后行远侧吻合口再通术提供理论支持。方法实验采用SD大鼠120只,随机分为6组,分别为:(1)神经单纯切断组;(2)神经切断缝合组;(3)神经移植修复组;(4)游离神经移植修复后远侧缝合口切除组;(5)游离神经移植修复后远侧缝合口切除再缝合组;(6)假手术组。术后1、2、4、8、12和16周取出脊髓腰膨大,进行组织学观察和免疫组化检测。结果实验组术后1周胞浆轻度水肿,线粒体肿胀,空泡化。术后2~4周,神经元超微结构的改变明显加重,术后4~8周进入恢复期。第3组术后1周,BDNF在运动神经元内表达开始增加,2周达到了高峰,8周下降。NGF的表达在术后2周开始上升,8周达到高峰,之后持续下降。第5组BDNF的表达在术后8~16周期间呈上升趋势,NGF的表达在术后8周一直维持平稳状态,而对照组各时间段无明显变化。结论长段神经移植修复术后,适时行远侧吻合口切除重新吻合,既去除了远侧吻合口的瘢痕,同时再次激活神经元功能的状态,有利于功能恢复。
Objective To observe the morphological and functional changes of spinal cord anterior horn cells after transplantation of distal anastomosis in rats and to provide theoretical support for distal anastomotic recanalization after long nerve graft. Methods 120 Sprague-Dawley rats were randomly divided into 6 groups: (1) nerve alone group; (2) nerve suture group; (3) nerve graft repair group; (4) after free nerve graft repair Distal suture resection group; (5) free nerve graft repair distal suture resection and suture group; (6) sham operation group. At 1, 2, 4, 8, 12 and 16 weeks after operation, lumbar enlargement of the spinal cord was removed for histological observation and immunohistochemistry. Results One week after operation, the cytoplasm had mild edema, mitochondria swelling and vacuolization. After 2 ~ 4 weeks, the ultrastructural changes of neurons were significantly aggravated, and the convalescence was observed 4 to 8 weeks after operation. One week after operation in group 3, BDNF expression began to increase in motor neurons, peaked at 2 weeks, and decreased at 8 weeks. The expression of NGF began to rise at 2 weeks after operation, peaked at 8 weeks, then continued to decrease. The expression of BDNF in group 5 increased from 8 to 16 weeks after operation, and the expression of NGF remained stable at 8 weeks after operation, while no significant changes were observed in the control group at each time point. Conclusion After a long period of nerve graft repair, distal resection of the anastomotic anastomosis can be performed timely and properly, which not only removes the scar of distal anastomosis but also reactivates the function of neurons, which is beneficial to functional recovery.