不同延迟修复时间对神经端-侧缝合效果影响的实验研究  

Experimental study of end-to-side neurorraphy after different intervals of delayed repair

作　　者：杨蓊勃[1] 虞聪[1] 陈琳[1] 杨剑云[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》2011年第3期164-167,共4页Chinese Journal of Hand Surgery

摘　　要：目的比较不同时间延迟修复对神经端一侧缝合疗效的影响，对动物实验结果与临床疗效之间存在差异的原因进行初步探讨。方法清洁级SD成年雌性大鼠30只，随机等分为5组：损伤后直接修复组（0d）；伤后1周（7d）修复组；伤后3周（21d）修复组；伤后6周（42d）修复组；对照组（controlling group，CG）。将大鼠右侧肌皮神经切断后旷置不同时间作为受体神经，以同侧尺神经作为供体神经。饲养3个月后，对实验动物进行神经电生理及病理组织学检测。结果术后3个月，在电生理、肌肉、神经组织病理学等项目，延迟1周修复组的各项指标均为各组中最佳，与其余各组相比，差异具有统计学意义；直接修复组与延迟3周修复组部分指标差异元统计学意义；而延迟6周后进行修复组，各项指标的恢复程度较低，与其他各组差异具有统计学意义（P〈0．05）。结论神经损伤后间隔不同时间进行修复，会对端一侧缝合的疗效造成影响；神经预变性1周后进行端一侧缝合可以达到较好的效果，但随着预变性时间的延长，手术效果逐渐变差；失神经支配后靶肌肉萎缩程度加重，其对神经端．侧缝合后功能恢复的影响可能是造成实验结果与临床疗效之间差异的原因之一。Objective To study the influence of different intervals of delayed repair on end-to-side neurorraphy and to discuss the possible reasons of the disparity between the experimental studies and the clinical applications. Methods Thirty female SD rats were subjected to musculocutaneous nerve transection and randomized into 5 groups. The musculocutaneous nerves were reconstructed in the end-to-side fashion with the ipsilateral ulnar nerve at different intervals of delay. No delay （0 d repair）, 1 week delay （7 d repair）, 3 week delay （21 d repair）, 6 week delay （42 d repair） and no repair （control） were the group assignments. Electrophysiological and histological examinations were carried out 3 months after the repair surgery. Results Evaluations conducted 3 months postoperatively showed that the 1-week delay group performed significandy better in eleetrophysiologieal and histological examinations than the other groups. There was no noticeable difference between no delay group and 3-week delay group in some tests. The outcomes were decreased in the 6-week delay group, which were significantly different from the other groups （ P 〈 0.05）. Conclusion The interval of delayed repair can influence the effectiveness of end-to-side neuron＇aphy after nerve injuries. The outcomes of the surgery were better after 1-week nerve pre-degeneration. However the therapeutic effect of end-to-side eoaptation decreased with the pass of time. Aggravation of muscle atrophy might be one of the possible masons to explain the incompatible results between the experimental studies and the clinical applications.

关 键 词：神经再生 WALLER变性 周围神经 端一侧缝合 神经预变性 

分 类 号：R651.3[医药卫生—外科学]