肌皮神经与尺神经端侧缝合重建屈肘功能的实验研究  

An experimental study of restoring elbow flexion after end-to-side neurorrhaphy using muscu-locutaneous nerve to ulnar nerve

作　　者：张东[1] 凌彤[2] 邵新中[2] 张克亮[2] 薛景凤[3] 

机构地区：[1]承德市中心医院骨科,067000 [2]河北医科大学三院手外科 [3]承德医学院解剖学教研室

出　　处：《实用手外科杂志》1999年第4期219-222,共4页Journal of Practical Hand Surgery

摘　　要：目的 研究周围神经端侧缝合后侧支发芽再生能力及用于臂丛上干撕脱伤重建屈肘功能的可行性.方法 选用24只Wistar大鼠.左前肢为实验侧:于距肱二头肌入肌点12mm处切断肌皮神经,远断与外膜开窗1.0mm×0.5mm的尺神经做端侧缝合.右前肢为对照侧:切断1/2尺神经束,近端与肌皮神经远断端做端端外膜缝合.按取材时间随机分为A、B、C三个时间组,每组8只,分别于术后3、6、12周取材,进行大体观察.神经组织学、电生理、肱二头肌收缩力和肌湿重、辣根过氧化物酶(HRP)示踪检测.结果A组实验侧再生纤维数目和B组实验侧动作电位振幅、潜伏期与对照例相比有显著性差异(P<0.01),实验侧均低于对照例.随术后时间的延长,其余各项指标无显著性差异(P>0.05).结论 肌皮神经与尺神经端侧缝合后确实存在侧支发芽能力,并获得部分神经肌肉功能恢复,为临床治疗臂丛神经上干撕脱伤重建屈肘功能提供了新思路.ve To study the collateral sprouting capacity of the peripheral nerve after end - to - side neurorrhaphy; to evaluate a new technique for restoring elbow flexion about the upper trunk of brachial plexus and its clinical value. Methods 24 healthy Wistar rats were divided into A、B、C groups randomly. The left forelimb served as the experimental side and the right forelimb as the contral one. The musculocutaneous nerve of the experimental side was transected, then its distal end was sutured to the ulnar nerve which had been windowed by means of end - to - side attachment. In the contral side, the musculocutaneous nerve was transected, and then its distal end was sutured to the part fascial of ulnar nerve with end-to-end neurorrhaphy . The gross、histological、electrophysiological、the amplitude and latency of action potential of the regenerate nerve fibers were examined; the wet weight& the twitch and tetanus of the biceps brachialis were measured; horseradish peroxidase (HRP) tracing technique was also performed in 3、6、12 weeks of postoperative intervals respectively. Results In early stage of the postoperation, both the number of the regenerated nerve fibers of the experimental side in group A and the amplitude、latency of the experimental side in group B were less than that of contral side, which made significant difference (P<0.01) . But with the progress of postoperation, the quantity of regenerated fibers was increased in group B. The latency became shortened and the amplitude of action potential was enhanced in group C, test outcomes of which made no significant difference (P>0.05) . In both of the experimental and contral side of group C, HRP labelling for motor neurons in the anterior horn of the spinal cord were positive. Conclusion The capacity of collateral sprouting after musculocutaneous nerve to ulnar nerve with end - to - side neurorrhaphy does exist. This technique provided a possible application to reconstruct elbow flexion for upper trunk avulsion of the brachial plexus in the rat model

关 键 词：肌皮神经 尺神经 缝合 屈肘功能 对照 撕脱伤 重建 数目 目的 取材 

分 类 号：R658.2[医药卫生—外科学] R651.3[医药卫生—临床医学]