恒河猴坐骨神经损伤修复后胫神经和腓总神经预后差异的研究  

COMPARISON OF HEALING RESULTS BETWEEN TIBIAL NERVE AND COMMON PERONEAL NERVE AFTER SCIATIC NERVE INJURY REPAIR IN RHESUS MONKEY

作　　者：张强[1] 陈汇浩[1] 刘国辉[1] 宗海洋[1] 林浩东[1] 侯春林[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中国修复重建外科杂志》2016年第5期608-611,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81572146)~~

摘　　要：目的研究恒河猴坐骨神经损伤修复后胫神经和腓总神经髓鞘变性与再生的变化规律及其轴突密度差异情况。方法取健康成年恒河猴9只,雌雄不限,体质量3.5~4.5 kg,通过锐性切割造成胫神经和腓总神经离断损伤模型。术中取3只动物,于损伤平面以远5 mm处切取长5 mm的胫神经及腓总神经作为正常对照;余6只采用神经外膜缝合法修复后,于术后3、8周各取3只行大体观察、神经电生理检测,并切取胫神经和腓总神经吻合口远端神经组织行Luxol Fast Blue染色,观察胫神经和腓总神经髓鞘变化情况,计算胫神经和腓总神经轴突密度和轴突再生率。结果术后实验动物均出现下肢肌肉萎缩及足趾不同程度溃疡。大体观察见吻合部神经膨大,周围结缔组织增生,粘连明显。术后3周未检测到胫神经及腓总神经复合肌肉动作电位(compound muscle action potential,CMAP),8周腓总神经CMAP波幅小于胫神经。组织学观察示,术后3周胫神经和腓总神经轴突均发生不同程度变性,以腓总神经变性明显,腓总神经轴突再生率为13.2%,显著低于胫神经的44.5%;术后8周胫神经和腓总神经均可见再生轴突,腓总神经轴突再生率为10.3%,仍显著低于胫神经的35.3%。结论与腓总神经相比,胫神经损伤修复后轴突退变速度慢、再生速度快,轴突再生比例高,其靶器官有更多神经纤维支配,靶肌肉CAMP恢复快、幅度高,胫神经功能恢复更好。Objective To investigate the regularity of myelin degeneraUon ana regenerauu,~ ~x^u of axonal density between tibial nerve and common peroneal nerve after sciatic nerve injury repair in rhesue monkey. Methods Nine adult rhesue monkeys （male or female, weighing 3.5-4.5 kg） were selected to establish the model of rat sciatic nerve transaction injury. The tibial nerve and common peroneal nerve of 5 mm in length were harvested at 5 mm from injury site as controls in 3 monkeys; the distal tibial nerve and common peroneal nerve were repaired with 9-0 suture immediately in the other 6 monkeys. And the gross observation and neural electrophysiological examination were performed at 3 and 8 weeks after repair respectively. Then, distal tibial nerve and common peroneal nerve at anastomotic site were harvested to observe the myelin sheath changes, and to calculate the number of axon counts and axonal density by staining with Luxol Fast Blue. Results Atrophy of the lower limb muscle and various degrees of plantar ulcer were observed. Gross observation showed nerve enlargement at anastomosis site, the peripheral connective tissue hyperplasia, and obvious adhesion. The compound muscle action potential （CMAP） of tibial nerve and common peroneal nerve could not be detected at 3 weeks; the CMAP amplitude of common peroneal nerve was less than that of the tibial nerve at 8 weeks. Different degrees of axonal degeneration was shown in the tibial nerve and common peroneal nerve, especially in the common peroneal nerve. The average axonal density of common peroneal nerve was lower than that of tibial nerve at 3 weeks （13.2% vs. 44.5%） and at 8 weeks （10.3% vs. 35.3%） after repair. Conclusion The regeneration of tibial nerve is better and faster than that of common peroneal nerve, and gastrocnemius muscle CMAP recovers quicker, and amplitude is higher, which is the reason of better recovery of tibial nerve.

关 键 词：坐骨神经损伤 腓总神经 胫神经 神经再生 恒河猴 

分 类 号：R651.3[医药卫生—外科学]