原位吻合修复腰神经根断裂伤的实验研究  

Repair of lumbar nerve rupture with in situ anastomosis in rats

作　　者：江曦[1] 陈爱民[1] 杨迪[1] 张志凌[1] 鹿楠[1] 朱磊[1] 李菁[1] 林浩东[1] 赵良喻[1] 叶添文[1] 李永川[1] 

机构地区：[1]第二军医大学长征医院创伤骨科,上海200003

出　　处：《中华创伤骨科杂志》2012年第9期786-791,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（30973054）

摘　　要：目的观察直接吻合对腰神经根性断裂伤的作用，探讨影响吻合效果的原因。方法成年SD大鼠共20只，随机分为吻合组和不吻合组（每组10只），另设吻合组右侧为吻合侧，左侧为健侧。术后观察各组大鼠的存活情况，对受试鼠进行行为学运动（BBB）评分；比较两组双侧股二头肌、小腿三头肌硬胫前肌湿醺比和萎缩比；电镜检查吻合口远端神经生长情况；真蓝逆行示踪、肌电图检查以评价吻合的有效性，利用HE染色及TUNNEL法检测吻合术后伤侧脊髓前角运动神经元存活及凋亡情况。结果术后12周吻合组BBB评分[（15．00±1．68）分]均较不吻合组[（8．60±3．27）分]高，差异有统计学意义（t=5．505，P=0．001）；两组肌肉湿重比、肌肉萎缩比比较差导均有统计学意义（P〈0．05）；吻合组不同肌肉间湿重比和萎缩比比较：胫前肌〈小腿三头肌〈股二头肌，差异均有统计学意义（P〈0．05）。荧光纤维镜下可见吻合后新生神经已通过吻合口。吻合组高于不吻合组，吻合组凋亡指数低于不吻合组，置异均有统计学意义（P〈0．05）。股二头肌肌电蹦恢复率优于胫前肌、小腿三头肌，差异有统计学意义（P=0．000）。结论腰神经根性断裂伤原位直接吻合能恢复大鼠坐骨神经的部分功能，且能部分保护脊髓前角运动神经元，吻合后神经纤维的丢失及神经生长速度慢于靶肌肉退变速度是影响术后功能恢复的重要原因。Objective To evaluate the ettects of in situ anastomosis on the ruptured sciatic nerve root. Methods The animal models of sacral nerve root avulsion were estahlished in 20 adult SD rats in which the right IA-L6 were avulsed out of the intervertebral foramina. They were randomized into 2 even groups （anastomosis versus non-anastomosis）. [n group A, we did not reconstruct the ruptured sciatic nerve. In group B. we in situ anastumosed the ruptured nerve roots of IA--L6. The histomorphology uf the nerves in each group was observed 12 weeks after operation under microscopy and electron microscopy. The models were evaluated in terms of survival, Basso Beattie Bresnahan （BBB） score, electron microscopic weight and muscle fiber CSA （cross section area） of double biceps femoris, triceps surae and tibial muscle. HE and TUNNEL were used to examine the survival and apoptosis of the motor neurons at the cornu auterius medullae spinalis uu the ruptured side after in situ anastomosis. Results At 12 weeks after operatiou, the BBB score of group B（15.00±1.68） was significantly higher than in group A （8.60±3.27） （t=5.505, P=0. 001）. A significant difference was observed between the 2 groups in muscle wet weight ratio amt muscle fiber CSA （ P 〈 0.05）. The double biceps felnoris had the largest muscle wet weight ratio and muscle fiber CSA, foftowed by the triceps surae arid last by the tibial muscle, with significant differences （ P 〈 0. 05）. Newly born nerve crossing the anastomosis was observed. The survival rate of motor neurons in group B was signifcantly higher than in group A and the apoptosis of motor neurons was significantly lowed than in group B （ P 〈 0. 05）. The recovery of double biceps femoris was significantly better than that of tibial muscle and triceps surae（ P = 0. 000）. Conclusions In situ anastomosis may be an effective way to repair the sciatic nerve root rupture hecause it can restore part of the neural function of the sciatic nerve and can preserve part of the mo

关 键 词：大鼠 软组织损伤 吻合术 外科 

分 类 号：R687.2[医药卫生—骨科学]