面神经保留程度对神经再生及重建眼轮匝肌功能影响的实验研究  

Experimental study on the effect of facial nerve retention on nerve regeneration and reconstruction of orbicularis muscle function

作　　者：庄园 王彬彬[1] 张绍东[1] 历俊华[1] 万虹[1] 冯洁[1] 李德志[2] 刘松[1,2] Zhuang Yuan;Wang Binbin;Zhang Shaodong;Li Junhua;Wan Hong;Feng Jie;Li Dezhi;Liu Song(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,100070 [2]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经外科杂志》2020年第2期188-193,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81471239)。

摘　　要：目的探讨保留不同程度的再生面神经对面神经-舌下神经侧-侧吻合术后大鼠眼轮匝肌功能重建的作用。方法采用随机抽样分组的方法,将40只大鼠分为4组(每组10只),4组大鼠均行面神经钳夹线拴损伤及面神经-舌下神经侧-侧吻合术(简称吻合术)。术后3个月,A组(对照组):模型建立后不做任何处理;B组:横截断结扎线近头端面神经1/3部分;C组:横截断结扎线近头端面神经2/3部分;D组:于面神经结扎线近头端全部离断面神经。分别于吻合术后1、2、3个月和横截断面神经1周后采用瞬目反应评分评估大鼠患侧眼睑的闭合程度;行运动诱发电位(MAPs)检测大鼠患侧眼轮匝肌的动作电位幅度及波幅下面积;神经元逆行示踪检测面神经核及舌下神经核内阳性神经元的数量;面神经及移植神经半薄切片计数髓鞘数目。结果4组大鼠吻合术后1、2、3个月的瞬目反应评分比较差异均有统计学意义(F值分别为12.47、11.00、10.61、19.13,均P<0.05);横截断面神经1周后4组瞬目反应评分的差异有统计学意义(F=29.06,P<0.05),其中D组分别低于A组和B组(均P<0.01);横截断面神经1周后,刺激面神经吻合口近头端及移植神经中点,4组的MAPs波幅及波幅下面积的差异均有统计学意义(F值分别为27.56、11.86、6.33、4.65,均P<0.05),其中D组的MAPs波幅及波幅下面积均低于A组(均P<0.05)。神经元逆行示踪显示,4组的面神经核内阳性神经元计数的差异有统计学意义(F=6.52,P<0.05),其中D组的阳性神经元数量分别低于A组和B组(均P<0.05)。4组的面神经干及移植神经中段髓鞘计数差异均有统计学意义(F值分别为8.33、6.35,均P<0.05),其中A组分别高于C组和D组(均P<0.05)。结论面-舌吻合术中保留面神经结构完整性具有积极意义,至少保留2/3再生面神经对眼轮匝肌恢复有利。Objective To investigate the effect of the regenerated facial nerve(FN)with varying degrees on the reconstruction of orbicularis function post facial-hypoglossal side-to-side neurorrhaphy(FN-HN)in the incomplete facial palsy model.Methods A total of 40 male adult Sprague Dawley rats were divided into 4 groups randomly.All rats were performed with crushed FN injury and FN-HN anastomosis.Three months later,the 4 groups were performed with FN cross section with different ratios at the proximal end to the injured site:no intervention in group A,1/3 of cross section in group B,2/3 of cross section in group C and transection in group D.The degree of closure of the affected-side eyelids in rats was assessed using the eye blink score,the muscle active potentials(MAPs)were used to detect the action potential and the area under the curve(AUC)of the rat′s orbicularis oculi muscle on the affected side,the number of positive neurons in the FN and HN nuclei were revealed by retrograde labeling,and the myelinated axons were counted on semi-thin sections of facial nerves and nerve grafts.Results For the eye blink scores,the 4 groups showed significant difference during the three months(F=12.47,11.00,10.61,19.13,all P<0.05)and after the cross section(F=29.06,P<0.05).Moreover,the score in group D was lower than that in group A and B(both P<0.01).One week after the cross-section of FN,all 4 groups showed significant difference in amplitude and AUC of MAPs when we stimulated the proximal end of anastomosis site of facial nerve and the middle of the nerve graft(F=27.56,11.86,6.33,4.65,all P<0.05).In addition,the amplitude and AUC of MAPs in group D were significantly lower than those in group A(both P<0.05).Among the 4 groups,retrograde labeling indicated significant difference in the number of positive neurons in the FN nucleus(F=6.52,P<0.05),and the neurons in group D were less than those in group A and B(both P<0.05).The counts of myelinated axons in both FN trunk and nerve graft in the 4 groups were significantly different(F=8.

关 键 词：吻合术 外科 面神经 舌下神经 眼轮匝肌 大鼠 

分 类 号：R651[医药卫生—外科学]