血管支架支撑静脉神经导管修复兔周围神经缺损的实验研究  

Vein Nerve Conduit Supported by Vascular Stent in the Regeneration of Peripheral Nerve in Rabbits

作　　者：孟维锟 黄仲[1] 谭振[1] 李亮[1] 郭强[1] 张震[1] 毋城玺 刘雷[1] 黄富国[1] 王光林[1,2] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]广安市人民医院骨科,广安638500

出　　处：《四川大学学报（医学版）》2017年第5期687-692,共6页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅科技支撑计划项目(No.2013FZ0066);四川省卫生和计生委员会普及应用项目(No.17PJ128);广安市2016年创新基金项目资助

摘　　要：目的探索血管支架支撑的自体静脉神经导管对新西兰大白兔周围神经缺损再生修复作用。方法新西兰大白兔30只,随机分为自体神经组(A组)、自体静脉神经导管组(B组)、血管支架支撑后的自体静脉神经导管组(C组)3组。分离并切除大白兔左后肢腓总神经约10mm,制备腓总神经缺损,A组将切除的腓总神经旋转180°后缝合于缺损处,B、C组:分离切取20mm长的颈外静脉,静脉回缩修剪后,B组将取下的静脉桥接于神经缺损处,C组将血管支架置入获取的颈外静脉,再接于神经缺损处。术后观察兔足部溃疡情况,进行兔左足展趾反射评分,术后12周,进行神经缺损修复的大体观察及电生理检测,比较各组兔左、右侧后肢腓肠肌湿质量比,并对修复的神经组织进行形态学观察和透射电镜检测,分析各组神经再生及功能恢复情况。结果术后各组均发现兔手术侧足跟部溃疡,以B组最严重,A组最好。术后12周A组展趾反射评分恢复最快且最好,C组次之,B组最差,组间差异有统计学意义(P<0.05)。电生理检测A组神经传导速度最快(64.01±5.61)m/s,C组次之(53.43±7.99)m/s,B组最差(29.15±4.45)m/s,各组之间差异有统计学意义(P<0.05)。腓肠肌湿重比A组>C组>B组,组间差异有统计学意义(P<0.05)。术后12周,A组再生神经形态正常,B组静脉导管坍陷,直径较小,C组自体血管支架支撑的静脉导管未塌陷,直径略大于A组。光镜及透射电镜观察发现再生神经束面积、纤维密集程度及髓鞘厚度均为A组和C组明显优于B组(P<0.05)。结论血管支架支撑自体静脉神经导管能够较好的促进新西兰大白兔周围神经缺损的再生。Objective To evaluate the effectiveness of autologous vein nerve conduit supported by vascular stent in repairing a 10 mm gap peroneal nerve in white New Zealand rabbits. Methods 30 New Zealand rabbits were randomly divided into three groups： autologous nerve group （group A）, conventional autologous vein nerve conduit group （group B）, autologous vein nerve conduit supported by vascular stent group （group C）. 10 mm common peroneal nerve was cut off. In groups A, the peroneal nerve was turned 180 before suturing. In group B and group C, 20 mm long external jugular vein was cut and removed. After dilution of venous retraction, the venous bridge filled the gap of the nerve defect in group B. In group C, a blood vessel stent was placed for accessing the external jugular vein and then connected to the nerve defect. Ulnar ulcer was observed after operations. Reflex score of left foot toe was recorded. The nerve regeneration and functional recovery was assessed through electrophysiological examinations, comparison of wet mass ratio between the left and right hind limb gastrocnemius, morphological observations, transmission electron microscopy 12 weeks after operations. Results Group B had the lowest scoring of toe-spreading reflex, whereas Group A had the highest scoring of toe-spreading reflex. There was a statistically significant difference in the scoring of toe-spreading reflex between group A and group C. In terms of the diameter of regenerated nerve fiber and the thickness of regenerated myelin sheath, no statistically significant （P〈 O. 05） difference was found between group A and group C, whereas the difference was significant （P〈0.05） betweengroups A/C and group B. The presence of peripheral nerves found in light microscopic examinations revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was almost equal between group B and group C under electron microscopic examinations. However, more degenerated axons with disturbed contoursin were found i

关 键 词：自体静脉神经导管 周围神经再生 血管支架 生物神经导管 

分 类 号：R745[医药卫生—神经病学与精神病学]