不同端-侧缝合方式修复周围神经的比较研究  

Comparative study of peripheral nerve reconstruction using different types of end-to-slde neurorrhaphy

作　　者：杨蓊勃[1] 虞聪[1] 陈琳[1] 杨剑云[1] 吴可晚[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040

出　　处：《中华手外科杂志》2010年第4期222-225,共4页Chinese Journal of Hand Surgery

基　　金：卫生部临床学科重点项目（2007-66）;上海市周围神经显微外科重点实验室课题基金资助项目（08DZ2270600）

摘　　要：目的比较周围神经标准端-侧缝合方式与其他变体在修复效果上的差异。方法SD大鼠126只，随机分为7组，将右侧肌皮神经切断，以同侧尺神经作为供体神经，按照端-端缝合组（end-to-end，E-E组）、端-侧缝合组（end-to-side，E-S组）、侧-侧缝合外膜开窗组（side-to-side，S-S组）、侧-侧缝合外膜不开窗组（side-to-side，S-S’组）、螺旋缠绕外膜去除组（spiral，Sp组）、螺旋缠绕外膜保留组（spiraI，sp’组）、阳性对照组（controlling group，CG组）制作模型，各组分别于术后1、2、3个月取材，进行神经电生理、病理组织学检测。结果术后3个月，各端-侧缝合组均有明显神经再生现象，但效果均不及端-端缝合组，各种端-侧缝合术式的变体与标准端-侧缝合方式相比差异不明显（P〉0．05），保留神经外膜的两组为各组中效果最差。结论神经外膜对端-侧缝合效果有影响，各种缝合方式差异无统计学意义，单纯通过手术方式提高神经端-侧缝合后神经再生能力的效果非常有限。Objective To compare the curative effect of standard end-to-side neurorrhaphy and other modifications. Methods A total of 126 SD rats were randomized into 7 groups. The right mnsculecutaneous nerves were transected in all animals. The ipsilateral ulnar nerve served as the donor nerve. In group 1 the ulnar nerve and mnsculocutaneous nerve were coaptated in an end-to-end fashion. In group 2, the mnsculecutaneous nerve was eoaptod with ulnar nerve in the standard end-to-side fashion. Side-to-side neurorrhaphy with and without an epineural window were undergone in group 3 and 4, respectively. In group 5 and 6, the recipient nerve was eoapted with the donor nerve in a helicoid pattern, with and without removal of the epineurium, respectively. The musculocutaneous nerve in group 7 was transected but not reconstructed to serve as control. Electrophysiolegical and histological analyses were performed in the 1st, 2nd and 3rd month postoperatively. Results By the end of the 3rd month postoperatively, regenerative signs were observed in all end-to-side neurorrhaphy groups. The curative effect of end-to-side coaptation was not as satisfactory as that of end-to-end neumtrhaphy. There was no significant difference among the end-to-side neurorrhaphy groups（ P 〉 0.05）. The most unsatisfactory result was observed in groups without removal of the epineural sheath. Condusion Epineurium had negative impact to nerve regeneration after end-to-side neurorraphy. There was no significant difference among various end-to-side coaptation patterns. Modification of surgical end-to-side neurorrhaphy techniques has limited effect on improving nerve regeneration.

关 键 词：周围神经 神经再生 模型 动物 端侧缝合 

分 类 号：R651.3[医药卫生—外科学]