周围神经单端侧与双端侧吻合修复神经缺损的远期疗效  

Long-term curative effects of one end-to-side and double end-to-side neurorrhaphy in treatment of peripheral nerve defects

作　　者：张志新[1] 路来金[1] 刘志刚[1] 陈雷[1] 

机构地区：[1]吉林大学第一医院手外科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2006年第4期701-704,共4页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅基金资助课题(19989783)

摘　　要：目的:探讨神经单端侧吻合与双端侧吻合修复周围神经缺损的远期疗效。方法:将15只新西兰大白兔的左右侧后肢共30侧分为3组:单端侧吻合组、双端侧吻合组和对照组,于术后各时间段对肢体进行大体指标的观测,于术后1年对各组进行神经电生理学指标、胫前肌最大等长强直收缩张力(ITF)的测定以及神经、肌肉的组织学及形态学指标的观测。结果:神经单端侧吻合组与双端侧吻合组相比,在各时间段两组神经功能恢复进度相同,在术后1年两组的神经干诱发电位潜伏期(latency)和诱发电位波幅(CMAP)、胫前肌最大ITF的测定值比较差异均无显著性(P>0.05),神经、肌肉组织学观察结果亦相近。结论:神经单端侧吻合与双端侧吻合在修复周围神经缺损时远期疗效相同;缺损神经可通过与邻近正常神经干的双端侧吻合实现再生纤维的自身连接,这种连接对损伤神经功能的恢复仅起部分作用。Objective To evaluate the long-term curative effects of one end-to-side and double end-to-side neurorrhaphy in treatment of peripheral nerve defects. Methods Thirty sides of hind limbs of 15 New Zealand white rabbits were divided into 3 groups： one end-to-side neurorrhaphy group （OES）, the common peroneal nerve was transected 10 mm below its bifurcation, the distal end of the peroneal nerve was sutured to the intact tibial nerve in an end-to-side mode; double end-to-side neurorrhaphy group （DES）, the common peroneal nerve was transected 10 mm below its bifurcation, the proximal and the distal end were sutured to the same side of the intact tibial nerve by end-to-side anastomosis with a 10 mm distance; and control group （C）. At regular time after the operation, the general state of hind limbs was observed and recorded. After 1 year recovery period, the electrophysiological indicators including the latency and the amplitude of the evoked potential of the nerve were measured; the mechanical function of the reinnervated muscle was appraised by measuring the maximum titanic force of the tibialis anterior muscle; and the histological and morphometric evaluation of the tibialis anterior muscle and the nerve specimens were also made. Results All results including the amplitude of the evoked potential of the nerve , the mass of the tibilis anterior muscle and the acreage of cross section of the myelinated axons in the distal peroneal nerve and the mechanical function of the tibilis anterior muscle in OES group were similar to them in DES group, there was no significant difference （P〉0. 05）. Conclusion The long-term curative effects of one end-to-side and double end-to-side neurorrhaphy are the same. The proximal end of the transected nerve can be reconnected with the distal end by double end-to-side neurorrhaphy, but the connected fibers have only partial effects on the recovery of the nerve.

关 键 词：周围神经/损伤 吻合术 外科 电生理学 

分 类 号：R651.3[医药卫生—外科学]