外束膜开窗影响神经端侧吻合法修复效果的实验研究  

End-to-side neurorrhaphy with perinearial window for peripheral nerve injuries:an experimental study

作　　者：贾英伟[1] 韦健[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]山西医科大学第二临床医学院骨科,太原030001

出　　处：《山西医科大学学报》2013年第6期439-442,504,共5页Journal of Shanxi Medical University

基　　金：山西高校科技研究开发基金资助项目(20091179)

摘　　要：目的比较神经端侧吻合处供支外束膜开窗与否对周围神经端侧吻合后神经再生的影响,观察外束膜开窗在神经端侧吻合法中的作用。方法选用40只健康SD大鼠,采用右侧腓总神经损伤修复模型。随机分为A,B两组,每组20只。每组将右侧腓总神经在其坐骨神经分支后3 mm处局部封闭,利刀切断,吻合于胫神经。A组神经远断端切成10°斜面,胫神经(供支)外膜不开窗,腓总神经与胫神经端侧吻合;B组神经远断端切成10°斜面,胫神经(供支)外膜开窗,腓总神经与胫神经行端侧吻合。术后第8周分别对三组大鼠进行组织形态学、腓肠肌湿重检测、肌电图、有髓神经纤维计数和神经示踪法观察。结果外束膜开窗组(B组)腓总神经内有髓神经纤维数、新生轴突数量、新生施万细胞、毛细血管均多于不开窗组(A组),且B组髓鞘生成较完整,有髓神经纤维及轴突直径较粗;在神经电生理传导方面B组潜伏期小于A组,且波幅较A组大;B组胫前肌肌湿重大于A组;荧光示踪剂显示B组较A组荧光强度恢复好,分布均匀,轴突排列较整齐。结论供支外束膜开窗行神经端侧吻合修复周围神经,神经纤维再生更好;外束膜开窗能获得更有效的神经再生。Abstract： Objective To explore and compare the effect of end-to-side neurorrhaphy with and without the perineurial window on nerve regeneration in peripheral nerve injury repair models.Methods Forty rats were randomized into groups A and B （n =20 in each group）.In two groups,the right peroneal nerve was transected and the distal stump was sutured to the tibial nerve.In group A,the distal end of the injured peroneal nerve was operated in an angle of 10° without epineurial and perineurial fenestration,and was end-to-side sutured to the tibial nerve.In group B,the distal end was operated in an angle of 10° with epineurial and perineurial fenestration,and was end-to-side sutured to the tibial nerve.Histomorphology,the tibialis anterior muscle wet weight,electromyogram,myelinated nerve counts and neuronal tracing with Dil were detected at the end of 8 weeks after operation.Results The number of myelinated nerve fiber,new axons,Schwann cells and capillaries in group B were more than those in group A.The myelination was more complete,and the diameters of myelinated nerve and axon were bigger in group B than those in group A.In neurophysiological conduction,the latency in group B was shorter than that in group A,and the amplitude in group B was bigger than that in group A.The tibialis anterior muscle wet weight in group B was heavier than that in group A.Fluorescence intensity was better,distribution was evener and the arrangement of axons was more regular in group B than those in group A.Conclusion The epineurial and perineurial fenestration in end-to-side neurorrhaphy can enhance to repair the peripheral nerve injury and improve the nerve regeneration.

关 键 词：外束膜开窗 端侧吻合 神经再生 

分 类 号：R651.3[医药卫生—外科学]