微环境对周围神经损伤端-侧移位缝合术后神经再生的影响  

Microenvironment on Nerve Regeneration in Peripheral Nerve Injury after Nerve End to Side Anastomosis

作　　者：梅远东[1] 祝伟[1] 顾晨[1] 顾玉东[2] 

机构地区：[1]常熟市第二人民医院手足外科,江苏常熟215500 [2]复旦大学附属华山医院手外科,上海200040

出　　处：《贵州医科大学学报》2016年第12期1435-1439,共5页Journal of Guizhou Medical University

基　　金：上海市周围神经显微外科重点实验室开放课题

摘　　要：目的:探讨微环境对周围神经损伤端-侧移位缝合术后神经功能的影响。方法:选取SD大鼠120只,随机分为假手术组(组A)、右侧肌皮神经离断后端-侧缝合至尺神经组(组B)、右侧离断神经端-侧缝合后局部植入神经营养因子组(组C)、右侧离断神经端-侧缝合后局部植入激活态雪旺细胞组(组D)以及右侧离断神经端-侧缝合后局部植入神经干细胞组(组E);于手术后第1、2、4、8周时观察各组大鼠患肢肌力恢复情况,采用梳洗试验以及肱二头肌湿重观察和评价各组大鼠的屈肘功能;分别于术后第1、2、4、8周时检测各组大鼠右侧肌皮神经复合动作电位传导速度(NCV)及右侧肱二头肌复合动作电位(CMAP),术后第8周荧光显微镜观察各组大鼠新生神经轴突数。结果:各组大鼠手术切口均一期愈合,无红肿及溃疡发生;梳洗试验显示2周时各组梳洗试验患肢屈肘活动较差,第4和第8周时组C、D、E屈肘活动有好转;术后组C、D、E肱二头肌湿重重于组B,但比组A轻(P<0.05);术后组C、D、E肌皮NCV快于组B,但比组A慢(P<0.05);各实验组肱二头肌CMAP波幅较组A低,组C、D、E较组B高(P<0.05);术后第8周的神经纤维轴突计数证实组C、D、E新生神经纤维轴突数少于组A,但多于组B(P<0.05)。结论:神经端-侧移位是治疗周围神经损伤的有效方法,局部植入神经生长因子、激活态雪旺细胞、神经干细胞均可促进端-侧缝合后神经再生。Objective： To explore the effect of microenvironment on nerve regeneration in peripheral nerve injury after end to side anastomosis. Methods： 120 SD rats were divided into sham operation group （ group A）, after transection of the right musculocutaneous nerve, end to side anastomosis to the ulnar nerve group （group B）, transection of the right musculocutaneous nerve, end to side anastomosis and local implantation of neurotrophic factor group （ group C） , transection of the right musculocutane- ous nerve, end to side anastomosis and local implantation of activated Schwann cells group （ group D） , transection of the right musculocutaneous nerve, end to side anastomosis and local implantation of neural stem cells group （ group E） ; 1,2, 4, 8 weeks after operation, the muscle force recovery condi- tion of affected side limb was observed, and the recovery of elbow flexion function was observed and e- valuated by using grooming test, and musculocutaneous nerve conduction velocity （NCV） and muscle compound action potential （CMAP） were detected; Nerve fiber axon number was were observed by flu- orescence microscopy in 8 weeks after end to side anastomosis. Results： All the operative incision were healed by first intension without swollen and ulcer. Grooming test showed that elbow flexion func- tion in groups B, C, D,E was relatively bad in 2 weeks after operation, and in 4, 8weeks, the ruction in groups C, D, E improved. NCV, CMAP, biceps wet weight and nerve fiber axon number in groups C, D and E were superior to group B （P 〈 0.05）, but worse than group A（P 〈 0.05 ）. There was no significant difference between groups C, D and E （P 〉 0.05）. Conclusion ： End-to-side anastomosis is an effective method for treating peripheral nerve injury. Locally implanting nerve growth factor, Schwann cells, neural stem cell could facilitate the nerve regeneration.

关 键 词：神经外科手术 缝合技术 神经营养因子 雪旺细胞 神经干细胞 

分 类 号：R612[医药卫生—外科学] R745.1[医药卫生—临床医学]