小肠黏膜下层和自体翻转静脉修复周围神经缺损的比较研究  

COMPARISON BETWEEN EFFECTS OF SMALL INTESTINAL SUBMUCOSA GRAFT AND INSIDE-OUT VEIN GRAFT ON REPAIRING PERIPHERAL NERVE DEFECTS

作　　者：谢雪涛[1] 张长青[1] 苏琰[1] 张开刚[1] 李四波[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2007年第2期149-153,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30371444)~~

摘　　要：目的比较小肠黏膜下层(small intestinal submucosa,SIS)和自体翻转静脉修复周围神经缺损的效果。方法取健康猪新鲜空肠,刮除黏膜层、浆膜层和肌层,制得SIS,消毒灭菌后干燥冷冻备用。36只雄性健康SD大鼠随机分为3组,每组12只。制备大鼠右侧坐骨神经10mm缺损模型,然后分别用SIS(A组)、自体颈外静脉翻转(B组)和自体神经移植(C组)修复,术后6、12周取材,通过组织切片、电生理检查、计算机图像分析和Trueblue逆行示踪来评价比较三者的修复效果。结果组织学观察各组术后6周和12周均见再生神经纤维,且A组较B组神经纤维稠密,髓鞘形成规则,纤维组织少,更为接近C组。术后12周电生理检查在神经传导速率上B组低于A组和C组,差异有统计学意义(P<0.05),而A组和C组比较差异则无统计学意义(P>0.05);在复合动作电位波幅上A组和B组差异无统计学意义(P>0.05),但均低于C组(P<0.05)。术后6、12周图像分析发现A组的单位面积轴突数量和神经组织所占百分比均高于B组(P<0.05),B组的再生轴突平均直径、单位面积轴突数量以及神经组织所占百分比均低于C组(P<0.05)。术后12周Trueblue逆行示踪,各组L3-6背根神经节均发现阳性神经元。结论SIS较自体翻转静脉更适合修复周围神经缺损,有望能成为替代自体神经移植的生物材料。Objective To make a comparison between the effects of the small intestinal submucosa （SIS） graft and the inside-out vein graft on repairing the peripheral nerve defects. Methods SIS was harvested from the fresh jejunum of the quarantined pig by curetting the musoca, the tunica serosa, and the myometrium; then, SIS was sterilized, dried and frozen before use. Thirty-six male SD rats were divided into 3 groups randomly, with 12 rats in each group. Firstly, the 10-mm defects in the right sciatic nerves were made in the rats and were respectively repaired with the SIS graft （Group A）, the inside-out autologous vein graft （Group B）, and the auto-nerve graft （Group C）. At 6 weeks and 12 weeks after the operations, the right sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by the histological examination, the neural electrophysiological examination, the computerized imaging analysis, and the Trueblue retrograde fluorescence trace. Results The histological examination showed that the regenerated nerve fibers were seen across the defects in the three groups at 6 weeks after the operations. The nerve fibers were denser, the formed nerve myelin was more regular, and the fibrous tissue was less in Group A than in Group B; the nerve regeneration was more similar between Group A and Group C. At 12 weeks after the operations, the neural electrophysiological examination showed that the neural conductive rate was significantly lower in Group B than in Groups A and C （P〈0. 05）, but no statistically significant difference was found between Group A and Group C （P〉0. 05）; the component potential wave amplitude was not statistically different between Group A and Group B; however, the amplitude was significantly lower in Groups A and B than in Group C （P〈0.05）. At 6 weeks and 12 weeks after the operations, the computerized imaging analyses showed that the axis-cylinder quantity per area and the nerve-tissue percentage were significantly greater in Group A

关 键 词：小肠黏膜下层 静脉翻转 周围神经缺损 自体神经移植 

分 类 号：R651.3[医药卫生—外科学] R329.28[医药卫生—临床医学]