腓肠肌外侧头肌支神经转移术对大鼠腓深神经损伤的修复作用  

Effects of Lateral Gastrocnemius Muscle Branch Nerve Transferring on Deep Peroneal Nerve Impairment in Rats

作　　者：李军[1,2] 刘长彬[1,2] 董学超 郭韵[1,2] 唐丽[1,2] 杜良杰[1,2] 高峰[1,2] 刘宏炜[1,2] 杨德刚[1,2] 王冲[1,2] 李建军[1,2] 

机构地区：[1]中国康复研究中心北京博爱医院脊柱脊髓神经功能重建科,北京市100068 [2]首都医科大学康复医学院,北京市100068

出　　处：《中国康复理论与实践》2016年第7期779-783,共5页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中央级公益性科研院所基本科研业务费专项资金重点支持课题(No.2013CZ-1)

摘　　要：目的探讨腓肠肌肌支神经转移术修复腓深神经损伤的可行性和有效性。方法 32只成年雌性Sprague-Dawley大鼠分成空白组、对照组、神经直接吻合组(腓深神经直接吻合)和神经转移组(腓肠肌外侧头肌支转移至腓深神经),每组各8只。术后12周,肉眼观察神经吻合口生长情况,测量胫神经各肌支长度(L1)、入肌点处直径(D1)、各肌支起点至腓骨颈平面的距离(S),腓总神经膜内可分离的最大长度(L2)、腓深神经的直径(D2),比较手术前后大鼠患肢腓神经功能指数(PFI)、复合肌肉动作电位(CMAP)波幅、神经传导速度(NCV)、胫前肌湿重、肌酸磷酸激酶(CK)酶活性。结果所有实验大鼠均L1<S,不能直接与腓骨颈处的腓深神经无张力吻合。神经膜内分离腓总神经后,比目鱼肌支和腓肠肌内、外侧头肌支均能与腓深神经无张力吻合。神经转移组PFI、CMAP波幅、NCV、胫前肌湿重、CK酶活性均优于对照组(P<0.05),与神经直接吻合组间无显著性差异(P>0.05)。结论腓肠肌外侧头肌支神经转移至腓深神经修复腓深神经在解剖上可行,但要实现无张力吻合需要将腓总神经向近端进行神经膜内无损伤分离。腓肠肌外侧头肌支神经转移术能有效恢复腓深神经功能。Objective To explore the feasibility and effectiveness of lateral gastrocnemius muscle branch nerve transferring for deep peroneal nerve injury. Methods Thirty-two adult female Sprague-Dawley rats were divided into control group（n=8）, sham group（n=8）, nerve direct repairing group（n=8） and nerve transferring group（n=8）. Twelve weeks after the anastomosis, the nerve anastomosis was observed visually, the length of lateral of gastrocnemius muscle branch（L1）, the diameter at the point of entering muscle（D1）, the maximum detachable length of nervus peroneus communis（L2）, the diameter of deep peroneal nerve（D2） and the distance between branch point and neck of fibula（S） were measured. The peroneal nerve functional index（PFI）, the amplitude of compound muscle action potential（CMAP）, nerve conduction velocity（NCV）, the weight of the tibialis anterior and the creatine kinase（CK） activity of theanterior tibial were compared among groups. Results L1S was found in all the rats, indicating that the proximal tibial nerve muscular branches could not directly anastomose with the deep peroneal nerve in the neck of fibula without tension. The PFI, amplitude of CAMP, NCV, weight of the tibialis anterior and CK activity all improved in the nerve transferring group compared with those in the control group（P〈0.05）, and were not different from the nerve direct repairing group（P〈0.05）. Conclusion It is feasible that lateral head muscular branches of gastrocnemius nerve transferring can repair deep peroneal nerve injury, which is needed to separate superficial peroneal nerve and deep peroneal nerve in the epineurium without damaging nerve for tension free neuroanastomosis. Lateral head muscular branches of gastrocnemius nerve transferring can repair the function after deep peroneal nerve injury.

关 键 词：腓深神经损伤 胫神经肌支 神经转移术 修复 大鼠 

分 类 号：R651.3[医药卫生—外科学]