移植段神经与周围静脉伴行修复长段周围神经缺损的实验研究  

NERVE TRANSPLANTATION AND ACCOMPANYING PERIPHERAL VESSELS FOR REPAIR OF LONG NERVE DEFECT

作　　者：孙强[1] 郑加法[2] 赵昌明[1] 

机构地区：[1]大连大学附属中山医院骨科,辽宁大连116001 [2]大连市第二人民医院骨科

出　　处：《中国修复重建外科杂志》2012年第7期832-836,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的观察长段神经移植后与周围静脉伴行修复长段周围神经缺损中,移植神经再血管化过程以及与神经再生的关系。方法取6～8月龄新西兰大白兔60只(体重2.0～2.5 kg,雌雄不限),制备左前肢正中神经约3 cm缺损模型,随机分成实验组与对照组(n=30)。对照组行正中神经原位吻合;实验组行正中神经原位吻合同时与肘静脉伴行,将移植神经外膜与血管外膜用神经吻合线缝合。术后1、2、4、8、12周行大体观察、电生理检测、病理组织学观察,术后12周行透射电镜观察,对比分析神经移植段再血管化过程、神经纤维再生及功能恢复情况。结果大体观察示,实验组术后1周出现再血管化,术后2、4、8、12周再血管化程度明显高于对照组。病理组织学观察示,术后8、12周,实验组神经纤维再生速度、质量、数量均优于对照组。术后2、4、8、12周,实验组与对照组正中神经神经传导速度分别为(10.32±0.94)、(13.14±1.22)、(22.68±1.16)、(24.09±1.27)m/s和(9.18±1.07)、(11.12±1.03)、(19.81±1.37)、(20.67±1.19)m/s,术后2、4、8周组间比较差异无统计学意义(P>0.05),术后12周组间比较差异有统计学意义(t=3.167,P=0.001)。术后12周透射电镜观察示,实验组髓鞘大小相近,鞘板脱层少,雪旺细胞形态正常,富含细胞器,其内可见正常微丝、微管及轴索内线粒体,轴索内线粒体无肿胀、空泡,嵴膜清晰,神经原纤维走行趋于正常。实验组有髓神经纤维面积、髓鞘厚度及轴突直径分别为(5.93±0.94)mm2、(0.72±0.12)μm、(3.12±0.12)μm,对照组分别为(5.28±0.72)mm2、(0.65±0.09)μm、(2.98±0.16)μm,差异均有统计学意义(t=3.736,P=0.002;t=3.271,P=0.002;t=4.533,P=0.001)。结论与周围静脉伴行的神经移植可促进兔移植神经段血管生成,对神经再生和功能恢复有明显促进作用。Objective To observe the revascularization process of transplanted nerve after transplantation of long nerve and accompanying peripheral vessels, to investigate its relationship with nerve regeneration. Methods The median nerve defect models of the left forelimb （3 cm in length） were made in 60 New Zealand rabbits （aged 6-8 months, weighing 2.0-2.5 kg, and male or female）, which were randomly divided into 2 groups （n=30）. In situ anastomosis of the median nerves was performed in the control group; in situ anastomosis of the median nerves was made in parallel to the surrounding elbow veins, the transplanted epineurium and the adventitia were sutured with nerve anastomosis line in the experimental group. After operation, the gross observation, electrophysiological testing, and histopathology observation was performed at 1, 2, 4, 8, and 12 weeks, and transmission electron microscope at 12 weeks to observe the revascularization of nerve grafts, nerve fiber regeneration, and functional recovery. Results In the experimental group, revascularization was observed at 1 week after operation, and the degree of revascularization was significantly higher than that in the control group at 2, 4, 8, and 12 weeks. At 8 and 12 weeks, the nerve fiber regeneration speed, quality, and quantity in the experimental group were better than those in the control group. At 2, 4, 8, and 12 weeks, the nerve conduction velocities were （10.32±0.94）, （13.14 ± 1.22）, （22.68 ± 1.16）, and （24.09 ± 1.27） m/s respectively in the experimental group, and were （9.18 ± 1.07）, （11.12 ± 1.03）, （19.81 ± 1.37）, and （20.67 ± 1.19） m/s in the control group, showing significant difference at 12 weeks after operation （t=-3.167, P=0.001）. At 12 weeks in the experimental group, the myelin sheath had similar size, less sheath plate delamination, normal Schwann cells and rich organelles, in which normal microfilaments, microtubules and axonal mitochondria were observed; axonal mitochondria had clear crest film

关 键 词：神经移植 长段神经缺损 血管伴行 兔 

分 类 号：R651.3[医药卫生—外科学]