自体非神经组织材料移植修复面神经短距离缺损  

Repair of facial nerve defect at short distance with autologous non-neural tissues materials graft

作　　者：李予鲁[1] 高志强[1] 王辉[1] 刘稳[1] 全仕明[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院耳鼻咽喉头颈外科,北京市100730

出　　处：《中国临床康复》2005年第26期138-140,i0006,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨应用自体非神经组织材料翻转静脉-骨骼肌移植替代自体神经移植修复面神经短距离缺损,观察其治疗效果。方法:实验于2004-04/2005-01在北京协和医院动物实验室、耳鼻喉科电生理实验室和神经科病理实验室完成。选取雄性新西兰兔10只,随机分为翻转静脉-骨骼肌复合移植组和自体神经移植组,5只/组。分别用自体内外面翻转的静脉内填充骨骼肌的复合移植体和自体神经移植修复右侧面神经上颊支10mm缺损。比较两种修复方法的效果,通过实验侧/正常侧最大复合肌肉动作电位的振幅和潜伏期来观察再生神经的功能恢复,以组织形态观察和有髓轴突计数分析再生神经的组织形态恢复,根据两侧上唇、触须和鼻尖形态及活动的对称性从外观上判断面神经麻痹的出现及其恢复情况。结果:按实际处理分析,共10只兔进入结果分析,每组各5只。①两组再生神经的功能恢复和组织形态恢复:翻转静脉-骨骼肌复合移植组实验侧/正常侧最大复合肌肉动作电位振幅比分别为103%,93%,80%,59%和50%;正常侧/实验侧潜伏期比分别为67%,75%,115%,62%和50%;有髓纤维恢复率分别为63%,68%,96%,39%和30%。自体神经移植组实验侧/正常侧最大复合肌肉动作电位振幅比分别为99%,95%,78%,64%和53%;实验侧/正常侧潜伏期比分别为78%,100%,80%,75%和67%;有髓纤维恢复率分别为71%,62%,47%,53%和51%。经独立样本t检验,两组再生神经功能恢复程度(振幅比、潜伏期比)、有髓纤维恢复率基本相似(t=0.05,P=0.961;t=0.509,P=0.624;t=-0.22,P=0.832),表明两组再生神经有等同的功能和形态恢复程度。再生神经的功能恢复程度与再生有髓轴突数量的多少不完全一致,不能单纯以有髓轴突数的多少来评价神经再生的效果。再生有髓轴突数量多,形态与正常神经相似,并且形成多个较大、排列相对集中的神经束时,功能恢复往往较好。②面神AIM： To explore a substitute of autologous nerve graft in repairing facial nerve short distance defect with autologous non-neural tissues material, inversion vein-skeletal muscles graft, and observe its therapeutic efficacy. METHODS： The experiment was done in the Animal Laboratory of Peking Union Medical Hospital, Electric Physical Laboratory of Department of Otorhinolaryngology and Pathological Laboratory of Department of Psychiatry. Ten male New Zealand rabbits were selected and randomly divided into inversion vein-skeletal muscles cograft group and self nerve grafting group with 5 rabbits in each group. The skeletal muscles cograft body filled in self internal and external surface inversion vein and self nerve grafting recovered the right side on nerve upper buccal branches 10 mm defection. The effect of the two kinds of recovery methods was compared. Amplitude and incubation of maximum compound muscles action potential on experimental side/normal side observed the functional restoration of regeneration nerve. The constitution form recovery of regeneration nerve was analyzed by constitution form observation and axis-cylinder with marrow. The appearance of facial paralysis and its recovery＇s condition was judged from external appearance according to the symmetry of labrum, cirrus, form and activity of nasal apex on the two sides. RESULTS： According to actual treat analysis, totally 10 rabbits were involved in the result analysis with 5 in each group. ① The functional restoration and constitution form restoration of regeneration nerve in the two groups： The amplitude of vibration ratio of maximum compound muscles action potential on experimental side/normal side in inversion veinskeletal muscles cograft group was 103%, 93%, 80%, 59% and 50% respectively; The ratio of incubation of normal side/experimental side was 67%, 75%, 115%, 62% and 50% respectively： The recovery ratio of fiber with marrow was 63%, 68%, 96%, 39% and 30% respectively. The amplitude of vibration ratio of maximum compound muscle

关 键 词：功能恢复 神经再生 肌 骨骼/神经支配 面神经麻痹/外科学 自体神经移植 面神经麻痹 组织材料 神经缺损 移植修复 再生神经功能恢复 

分 类 号：R651.3[医药卫生—外科学] R277.751.2[医药卫生—临床医学]