螺旋式改良神经端侧缝合法修复周围神经损伤的实验研究  

Modified spiral end-to-side neurorrhaphy for peripheral nerve injury reconstruction： an experimental study

作　　者：贾英伟[1] 梁炳生[1] 张登峰[1] 常文凯[1] 乔虎云[1] 陈治[1] 李刚[1] 

机构地区：[1]山西医科大学附属第二医院骨科,太原030001

出　　处：《中华手外科杂志》2013年第1期49-52,共4页Chinese Journal of Hand Surgery

基　　金：山西高校科技研究开发项目（20091179）

摘　　要：目的对治疗周围神经损伤的常规端侧缝合方法进行螺旋式改良端侧缝合实验研究，观察神经再生修复效果，为周围神经损伤的治疗提供效果更好的修复方法。方法选用60只健康SD大鼠，采用右侧腓总神经修复模型。术中根据手术方法的不同，随机分为A、B、C三组，每组20只。每组将右侧腓总神经在其坐骨神经分出后3mm处局部封闭，利刀切断。A组神经远断端切成90°断面，行腓总神经端端缝合；B组神经远断端切成450斜面，同时供体神经干外束膜开窗行端侧缝合；C组神经远断端切成10°斜面，供体神经干外束膜开窗，以螺旋式改良端侧缝合法进行神经束膜及外膜缝合。术后第8周分别对各组大鼠进行组织学、肌湿重、神经电生理检测，有髓神经纤维计数及神经示踪法观察。结果螺旋式改良缝合组（C组）观察指标均优于常规端侧缝合组（B组）（P〈0．05），与端端缝合组（A组）比较差异元统计学意义（P〉0．05）。螺旋式改良端侧缝合法对促进神经纤维的再生明显优于常规端侧缝合法。结论神经断端采用螺旋式改良缝合后，神经再生良好；螺旋式改良缝合法较常规端侧缝合法能获得更有效的神经再生；长人远端的神经纤维多少与受端缝合接触面积大小有关。当临床遇动力神经缺乏时，采用神经螺旋式改良端侧缝合法可获得更好的修复效果。Objective To study and compare the effect of normal end-to-side neurorrhaphy and modified spiral end-to-side neuron＇haphy in an animal model, and provide basis for choosing a better nerve repair method in clinical application. Methods Sixty rats were randomized into 3 groups （A, B and C, n = 20）. In all groups, the right peroneal nerve was transected at the level 3 nan distal to its take-off from the sciatic nerve. In group A, the distal end of the injured pemneal nerve was cut at an angle of 90 degrees, and sutured in an end- to-end fashion. In group B, the distal end was transected at an angle of 45 degrees, and sutured in an end-to-side neurorrhaphy fashion with an epineurial window in the donor nerve. In group C, the distal end was cut at an angle of 10 degrees, and sutured in a modified spiral end-to-side neurorrhaphy fashion with more epineurial windows in the donor nerve. Histological, electromyographic, muscle wet weight analysis, myelinated nerve counts and neuronal tracing with Dil were performed at the end of 8 weeks postoperatively. Results In group C, the recipient peroneal nerve had regenerated better than that in group B. The difference between group C and group B was significant （ P 〈 0. 05）, while there was no significant difference between group C and group A （ P 〉 0. 05）. Conclusion The modified spiral end-to-side neurorrhaphy can enhance axonal sprouting from the donor nerve and improve the fimctional recovery. The donor nerve epineurial window surface area, the contact configuration and the distal end area of the injured peroneal nerve are the im^rtant factors to the end-to-side coaptation model.

关 键 词：端侧缝合 螺旋式改良缝合 周围神经损伤 神经再生 

分 类 号：R651.3[医药卫生—外科学]