吻合口位置对周围神经端侧吻合术后神经再生的影响  

Influence of coaptation position to the nerve regenerating after end-to-side neurorrhaphy

作　　者：杨立民[1] 李秀华[1] 张基仁[1] 齐勇[1] 肖强[1] 张彩顺[1] 吴月欣[1] 

机构地区：[1]辽宁医学院附属第一医院,辽宁锦州121000

出　　处：《山东医药》2011年第26期26-28,共3页Shandong Medical Journal

基　　金：辽宁省教育厅高等学校科研基金资助项目(L2010338)

摘　　要：目的观察吻合口位置对神经端侧吻合术后再生神经的影响。方法取新西兰大白兔58只,随机选10只为定位组,行胫神经干功能束鉴定,确定运动神经纤维集中、混合神经集中位置;余48只随机分为A、B组,各24只,切断腓总神经远端,并与外膜开窗的胫神经端侧缝合。A组为实验组,吻合口位于运动神经纤维集中处;B组为对照组,吻合口位于混合神经纤维集中处。于术后1、2、3个月,A、B组每次各取8只,于吻合口近端行电生理检测,取吻合口远端0.5 cm处的腓总神经进行组织学及抗神经丝蛋白免疫组化检测。结果光镜下可区分有髓神经纤维及无髓神经纤维团块并定位。随着术后时间延长,A、B组再生神经诱发电位的潜伏期逐渐缩短,波幅逐渐增大、肌湿重和肌纤维截面积逐渐增大、腓总神经有髓神经纤维数和神经束截面积显著增大,抗神经丝免疫组化阳性表达逐渐增强,且A组均优于B组。结论周围神经端侧吻合时,吻合口位于运动神经束集中处,其再生的运动神经纤维数目多,质量高,所支配肌肉的功能恢复较好。Objective To study the influence of coaptation position to the nerve regenerating after end-to-side neurorrhaphy.Methods 58 healthy Zealand rabbits were randomly divided into three groups.Ten animals for positioning group were identified with tibial nerve.Others were divided into group A（experimental group） and group B（control group）.Anastomosis position of group A lies at the motor nerve fibers concentrated,while one of group B lies at the mixed nerve fibers concentrated.1,2,3 months after surgery,electrophysiological test was done at proximal anastomosis and immunohistochemistry was done at 0.5 cm distal anastomosis of the common peroneal nerve.Results Myelinated nerve fibers and unmyelinated fiber clumps were distinguished in the light microscope.With prolonged operation,regenerated nerve′s evoked potentiallatency gradually shortened,amplitude increased,muscle wet weight and cross-sectional area of muscle fiber increased,the number of myelinated nerve fibers and cross-sectional area of nerve bundles in common peroneal nerve were significantly larger,expression of anti-neurofilament gradually increased,and the group A was better than group B.Conclusions Anastomosis lie at the motor nerve focus in the end-to-side anastomosis of peripheral nerve,the regenerating motor nerve fibrers will be more and better,and its dominant muscle function recover better.

关 键 词：周围神经 端侧吻合术 神经再生 

分 类 号：R658.2[医药卫生—外科学]