端端吻合与端侧吻合治疗臂丛神经上干损伤实验研究  

EFFICACY COMPARISON OF END-TO-END AND END-TO-SIDE NEURORRHAPHY IN TREATMENT OF BRACHIAL PLEXUS UPPER TRUNK INJURY

作　　者：邓凯[1] 张克亮[2] 王素云[3] 李秀荣[1] 张华[1] 马维[1] 

机构地区：[1]河北医科大学第二医院骨科,石家庄050000 [2]河北医科大学第三医院手外科 [3]河北省人民医院血液内科

出　　处：《中国修复重建外科杂志》2010年第11期1302-1305,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河北省卫生厅青年科技攻关项目(2007196)~~

摘　　要：目的采用端端吻合和端侧吻合尺神经与肌皮神经肱二头肌肌支,观察周围神经再生和效应肌恢复情况。方法雄性SD大鼠60只,体重200～250g,随机分成A、B两组(n=30)。均制作肌皮神经损伤模型,并在相同水平,A组采用1/12尺神经束支与肌皮神经肱二头肌肌支端端吻合,B组将肌皮神经肱二头肌肌支与尺神经主干端侧吻合。分别于术后4周和12周取材,行神经电生理检测、肱二头肌湿重比、肌纤维横截面积测定和有髓神经纤维计数(count of myelinated nerve fibers,CMF),并观察实验大鼠行为改变。结果术后4周,B组神经传导速度(nerve conduction velocity,NCV)延迟较A组明显,潜伏期波幅(amplitude,AMP)较A组减小,差异均有统计学意义(P<0.05);术后12周,A、B组NCV及AMP均相近,组间差异均无统计学意义(P>0.05)。术后4、12周,A、B两组肱二头肌湿重比以及肌纤维横截面积差异均无统计学意义(P>0.05)。术后4周,A组CMF为230.15±60.25,B组为160.73±48.77,组间差异有统计学意义(P<0.05);术后12周,A组CMF为380.26±10.01,B组为355.63±28.51,组间差异无统计学意义(P>0.05)。结论采用端侧吻合与采用端端吻合尺神经部分束支(1/12)的方法治疗臂丛神经上干损伤恢复肱二头肌功能,远期疗效相似。Objective To study and compare the effect of end-to-end and end-to-side neurorrhaphy between the recipient＇s musculocutaneous nerve and the donor＇s ulnar nerve,and to observe the regeneration of peripheral nerve and muscle refection. Methods Sixty male SD rats（weighing 200-250 g） were randomized into 2 groups（n=30 per group）,and made the musculocutaneous nerve injury model.In group A,the donor＇s nerve was transected for end-to-end neurorrhaphy.In group B,an epineurial window was exposed and the distal end of the muscle branch of musculocutaneous nerve was sutured to the side of the ulnar nerve.Electromyography was performed,biceps wet weight ratio,muscle fiber cross-sectional area,and count of myelinated nerve fiber（CMF） were measured at 4 and 12 weeks postoperatively.The behavior changes of the rats were observed. Results At 4 weeks,the nerve conduction velocity（NCV） and the latency amplitude（AMP） of group A were significantly higher than those of group B（P 0.05）;at 12 weeks,there was no significant difference in the NCV and AMP between groups A and B（P 0.05）.At 4 and 8 weeks,there was no significant difference in biceps wet weight ratio and muscle fiber cross-sectional area between groups A and B（P 0.05）.At 4 weeks,the CMF was 230.15 ± 60.25 in group A and 160.73 ± 48.77 in group B,showing significant difference（P 0.05）;at 12 weeks,it was 380.26 ± 10.01 in group A and 355.63 ± 28.51 in group B,showing no significant difference（P 0.05）. Conclusion Both end-to-end and end-to-side neurorrhaphy have consistent long-term effect in repair of brachial plexus upper trunk injury.

关 键 词：臂丛神经上干损伤 尺神经 肌皮神经肱二头肌肌支 端端吻合 端侧吻合 大鼠 

分 类 号：R651.3[医药卫生—外科学] R745[医药卫生—临床医学]