利用预变性神经移植物行舌下神经-面神经吻合术治疗完全性面瘫的实验研究  

Hypoglossal -facial nerve reconstruction with predegenerated nerve graft for treatment of complete facial palsy

作　　者：冯洁[1] 苏迪娅 历俊华[1] 李德志[2] 万虹[1] 刘松[1,2] 

机构地区：[1]首都医科大学北京市神经外科研究所,100050 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华神经外科杂志》2014年第4期360-363,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金项目（31340030）;北京市自然科学基金资助项目（7142031）

摘　　要：目的观察利用预变性神经移植物行舌下神经一面神经吻合术修复完全性面瘫的治疗效果。方法30只大鼠分为四组：A组：健康对照组，不做任何处理；B组：离断面神经后不做任何处理；c组：离断面神经后1周即刻修复；D组：离断面神经后9周延迟修复。鼻尖偏离指数实验检测面容对称性；神经电生理检测肌动作电位；半薄及超薄切片观察髓鞘再生；逆行示踪法检测舌下神经的再生。结果鼻尖偏离指数实验检测0【角度，修复术后4个月c组比D组仪角恢复明显（P〈0．01）；肌动作电位检测c组的振幅和峰面积值明显高于D组（P〈0．05）。半薄切片显示C组和D组神经移植物内新生髓鞘的数量分别为（1239±192）个和（559±224）个。超薄切片观察可见C组和D组大鼠神经移植物和与其吻合的面神经中，绝大部分（〉90％）为有髓鞘神经纤维，髓鞘直径为1．0—6．5μm。逆行示踪显示，在修复术后4个月，c组的舌下神经核中CTB—Alexa555和FG双标记神经元数量明显多于D组（P〈0．05）。结论利用预变性神经移植物行舌下神经一面神经吻合术早期治疗完全性面瘫，有助于受神经支配的面肌功能恢复，能够有效地治疗完全性面瘫。Objective To study the hypoglossal- facial nerve anastomosis method combined with predegenerated nerve graft for the treatment of facial palsy in aduh rats after facial nerve injury. Methods 30adult male Fisher 344 rats were grouped into A （intact） , B （injury）, C （reconstruction at 1 week after injury） , and D （reconstruction at 9 weeks after injury）. The treatment was assessed by the angle ot analysis, electrophysiological examination, electron microscopy analysis and retrograde labeling. Results The group D was found a higher recovery of facial symmetry compared to group C （ P 〈 0. 01 ）. MAPs displayed significantly greater amplitude and surface values in the group D compared with group C （ P 〈 0.05 ）. Analysis of semithin sections showed numerous regenerating myelinated axons and there were 1 239 ＋ 192 ~ 559 ＋ 224 myelinated axons in group C and group D, respectively. The analysis of uhrathin sections found that the majority （ 〉 90% ） of myelinated axons were 1.0 - 6. 5 I^m in their greatest diameter （including the thickness of their myelin）. Among these axons, 41% in group C were larger than 3 p^m in their greatest diameter, as compared with only 29% in group D. There were significantly more double - labeled （ CTB - Alexa555 and FG） hypoglossal motoneurons in the rats treated immediately as compared with the number in rats treated after a delay of 9 weeks （ P 〈 0. 05 ）. Conclusions The hypoglossal - facial nerve anastomosis method combined with predegenerated nerve graft was effective for the treatment of complete facial palsy in adult rats after facial nerve injury.

关 键 词：面神经损伤 吻合术 外科 移植物 大鼠 

分 类 号：R651.3[医药卫生—外科学]