副神经移位膈神经后膈肌运动诱发电位与病理学对照研究  

Motor evoked potential and pathology research about this diaphragm after transposition of accessory nerve and phrenic nerve

作　　者：周许辉[1] 贾连顺[1] 袁文[1] 严望军[1] 张咏[1] 

机构地区：[1]第二军医大学长征医院骨科,上海200003

出　　处：《中国矫形外科杂志》2007年第14期1091-1093,共3页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(30571886)

摘　　要：[目的]探讨副神经移位膈神经重建高位颈髓损伤大鼠呼吸功能后膈肌的病理学变化及膈肌运动诱发电位(motion evoked potential,MEP)的特点。[方法]健康雄性SD大鼠60只。随机分为1～6个月6个时间组。取下颈部正中切口,将双侧副神经在锁骨下水平发出内、外侧支之前切断,移位缝接膈神经干起始部。术后第1～6个月各组样本取颈后正中切口,切除C3全椎板充分显露颈髓并于C3、4水平锐性横断。证实胫前肌MEP完全消失后,于两侧腋前线肋下缘作切口,显露该处膈肌腹腔侧。直视下将同心针电极于腋前线第9肋骨下缘垂直胸壁插入膈肌肋部,监测其MEP的变化。然后完整取出膈肌,于电子天平称重。并于右侧腋前线顺膈肌肌纤维方向切取2 mm宽肌条行HE染色。分析膈肌肌纤维截面积的变化。[结果]神经移位后随着时间延长,大鼠膈肌MEP潜伏期逐渐缩短,波幅逐渐增大。6个月组MEP波幅为(6.35±0.51)mV,潜伏期为(3.41±0.36)m s。同时,膈肌逐渐饱满,肌重逐渐恢复,6个月为正常对照组的(97.23±4.07)%。肌纤维截面积也逐渐增大,6个月组达(1 741±439)μm2为正常对照组(1 809±461)μm2的(98.28±3.65)%。6个月组的各数据与对照组比无显著差异(P>0.05)。[结论]从电生理及病理学来看副神经可作为运动神经移位膈神经重建高位颈髓损伤后呼吸功能。[ Objective] To study the features of the motion evoked potentials and pathology of the diaphragm after the respiratory function reconstruction in the rats with upper cervical cord injuries through transposition of accessory nerve and phrenic nerve. [Method]Sixty male adult-rats were divided into six time-based groups （at 1,2, 3, 4, 5, 6 month interval） after its ac- cessory nerve were cut subclavicularly upside the embranchment of the interior and exterior branches, and were sutured with phrenic nerve trunk on both sides . After 1, 2, 3, 4, 5, and 6 months respectively, its were operated with C3 laminectomy and the cervical spinal cord transecting at the level of C3、4 by cervical posterior approach. The abdominal side of the diaphragm was exposed. The electrodes were inserted into the diaphragm perpendicular to the chest wall and along the inferior border of ninth rib at the anterior line of axilla. The latent periods and the amplitudes of the MEP in the diaphragm of the rats were recorded. Then the diaphragm of the rats was taken out and weighted on the electrical scale. A piece of 2 millimeter of the diaphragm was cut along with the myofiber adjacent to the right anterior axilla line. The specimen was fixed and HE stained. The change of transverse area of the cell of diaphragm was analyzed. [ Result] As time elapsed, after the rats had been performed with the accessory nerve transposition to phrenic nerve, the latent periods of the diaphragm MEPs in the rats curtailed, while the wave amplitude enlarged. In the rats of 6 months group, wave amplitude was （6.35 ± 0.51 ） mV and the latent period was （ 3.41 ±0.36） ms. The diaphragm was beginning to plump up and was gaining weight increasingly. And it was （97.23± 4.07 ） % of the control group 6 months later.At the same time the transverse area of the myofiber augmented to （ 1741 ±439） μm^2 in the rats of 6 months, accounting for （98.28 ±3.65 ） % of the normal control group, which was （ 1809 ± 461 ） μm^2. Each of time no statisti

关 键 词：膈神经 副神经 膈肌 运动诱发电位 病理学 

分 类 号：R651.2[医药卫生—外科学]