副神经移位膈神经与膈神经原位吻合后远端运动纤维通过率的对比研究  

The comparing study about the passing rate of the motor fibers at the distal anastomose between the accessory nerve sutured to phrenic nerve and the phrenic nerve anastomosed original site

作　　者：黄照国 贾连顺[2] 严望军[2] 周许辉[2] 

机构地区：[1]安徽省宣城市人民医院骨科,242000 [2]上海长征医院骨科

出　　处：《齐齐哈尔医学院学报》2011年第17期2741-2743,共3页Journal of Qiqihar Medical University

摘　　要：目的对比研究副神经移位膈神经与膈神经原位吻合后远端运动纤维通过率的变化特点,为副神经移位膈神经重建高位颈髓损伤后呼吸功能提供理论依据。方法健康雄性SD大鼠60只,体重250～270g。随机分成1、2、3、4、5、6月六个时间组。经颈前路正中切口显露右侧膈神经干于起始部切断,将右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。左侧膈神经平锁骨水平切断后原位吻合。术后第1、2、3、4、5、6月各组均取颈部正中切口显露两侧吻合的神经。分别于吻合口远、近端5mm处取材。用亚铁氰化铜法进行乙酰胆碱酯酶(AChE)组织化学染色。利用VIDS-Ⅲ型图像分析仪对运动纤维计数,远端与近端相除后得出远端运动纤维通过率。并将左、右两侧得到的数据进行分析。结果神经吻合后随着时间的延长,两侧吻合口远端运动纤维通过率均逐渐增加。右侧第1个月的通过率为(43.86±5.21)%。第6个月为(97.55±6.93)%。左侧第1个月的通过率为(45.03±5.65)%。第6个月为(98.02±5.51)%。两侧间的差异无明显的统计学意义(P>0.05)。结论从神经移位后吻合口远端运动纤维通过率的角度观察,副神经可作为动力神经缝接膈神经来重建高位颈髓损伤后呼吸功能。Objective To compare the passing rate of the motor fibers in the distal anastomose between the accessory nerve sutured to phrenic nerve and the phrenic nerve anastomosed original site,providing the histochemical data for respiratory function reconstruction by transposition of accessory nerve to phrenic nerve in the rats with upper cervical cord injuries.Methods 60 male rats,weight between 250-270 gram,were divided into 6 groups（form the first month to sixth month with one month interval） at random.Bilateral phrenic nerve was exposed and cut through the anterior cervical approach.The right accessory was cut subclavicularly upside the embranchment of the interior and exterior branches and sutured to phrenic nerve.The left accessory was anastomosed at original site.The rats were sacrificed on 1,2,3,4,5,and 6 months later according time by anterior cervical approach to expose the anastomose nerves.The nerve fibers 5 millimeters distal and proximal of anastomose were taken out and was stained by AchE histochemically with Kamorsky-roos method.The count about motor fibers at proximal and distal to the anstomosis was analyzed with the VIDS-Ⅲ graphical machine.The distal count divide into the proximal count to get the passing rate about the motor fibers.The numeric value of right and left was compared.Results As time passed after nerve anastomose the passing rate of motor fibers gradually increased in the distal anastomose.On the right,the passing rate was 43.86±5.21% at the first month,and 97.55±6.93% at the sixth month.On the left,The passing rate were 45.03±5.65% at the first month,and 98.02±5.51% at the sixth month.There was no statistically significant different between both sides（P0.05）.Conclusions According to the passing rate of the motor fibers in the distal anastomose on transporting accessory nerve to phrenic nerve,it is possible to reconstruct respiratory function by transporting accessory nerve to phrenic nerve in the rats with upper cervical cord injuries.

关 键 词：膈神经 副神经 脊髓损伤 

分 类 号：R651.3[医药卫生—外科学]