两种健侧颈7移位下干的术式修复大鼠全臂丛神经损伤的疗效比较研究  

Comparative study on the treatment efficacy of two surgical procedures of contralateral C,transfer for repairing the lower trunk in rats with total brachial plexus nerve injuries

作　　者：江烨 王立[2] 赵新 高凯鸣 于虎 劳杰 Jiang Ye;Wang Li;Zhao Xin;Gao Kaiming;Yu Hu;Lao Jie(Department of Orthopedics,Shanghai Eighth People's Hospital,Shanghai 200235,China;Department of Hand Surgery,the Third Hospital of Hebei Medical University,Shjiazhuang 050051,China;Department of Hand Surgery,Huashan Hospital Afiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]上海市第八人民医院骨科,上海200235 [2]河北医科大学第三医院手外科,石家庄050051 [3]复旦大学附属华山医院手外科,上海200040

出　　处：《中华手外科杂志》2024年第5期466-471,共6页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金(81070984);上海市周围神经显微外科重点实验室课题(17DZ2270500)。

摘　　要：目的 比较健侧颈7经颈椎前路直接移位于伤侧下干与健侧颈7通过游离神经移植桥接伤侧下干修复大鼠全臂丛神经损伤的疗效.方法 将90只成年Sprague Dawley大鼠随机分为三组,每组30只:A组(健侧颈7经颈椎前路直接移位伤侧下干组)、B组(健侧颈7-游离神经移植—伤侧下干组)和C组(健康对照组).设定左侧为伤侧,切断臂丛神经建造全臂丛神经损伤模型,按分组采用不同术式修复下干.比较三组大鼠术后4、8和12周的电生理检查、肌张力测试、肌纤维横截面积测量和神经纤维计数结果,评估两种术式对全臂丛损伤的下干修复效果.结果 神经电生理检查结果显示,术后A、B组尺侧腕屈肌与指浅屈肌复合肌肉动作电位潜伏期均测得一定程度的恢复,术后8、12周,A组潜伏期短于B组(P<0.05),A、B两组尺侧腕屈肌与指浅屈肌复合肌肉动作电位最大波幅比较,A组波幅大于B组,差异有统计学意义(P<0.05).肌张力测试结果显示,术后4、8、12周,A组前臂屈肌群肌张力恢复优于B组,但A、B组均小于C组,差异均有统计学意义(P<0.05).肌纤维横截面积测量结果显示,术后4、8、12周,A组尺侧腕屈肌和指浅屈肌横截面积大于B组,差异有统计学意义(P<0.05),但未恢复正常.神经纤维计数结果显示,术后8、12周,A组正中神经及尺神经纤维平均直径及总数均大于B组,差异有统计学意义(P<0.05),但未恢复正常.结论 健侧颈7通过游离神经移植桥接伤侧下干修复大鼠全臂丛神经损伤是可行的,从神经电生理、神经肌肉组织学检测结果可见恢复效果,但较健侧颈7经颈椎前路直接移位伤侧下干的修复效果差.Objective To compare the treatment efficacy of direct transfer of contralateral C,to the lower trunk via the prespinal route and bridging contralateral C,to the lower trunk with free nerve transplantation for repair of total brachial plexus nerve injury in rats.Methods Ninety adult Sprague Dawley rats were randomly divided into three groups,with 30 rats in each group,Group A(direct transfer of contralateral C,to the lower trunk via the prespinal route),Group B(bridging contralateral C,to the lower trunk with free nerve transplantation),and Group C(healthy control).The left side was set as the injured side,the brachial plexus nerve was cut off to construct a total brachial plexus nerve injury model,and the lower trunk was repaired using different surgical procedures according to grouping.The results of electrophysiological study,muscle tetanus contraction force test,cross-sectional area of muscle fiber,and axon countsat 4,8,and 12 weeks after surgery in three groups of rats were compared to evaluate the lower trunk repair efficacy of the two surgical procedures on total brachial plexus injury.Results The results of the neuro-electrophysiological examination showed that the latency of compound muscle action potential(CMAP)recorded from the flexor carpi ulnaris muscle(FCU)and the flexor digitorum superficialis muscle(FDS)in Group A and B recovered to a certain extent after surgery.At 8 and 12 weeks after surgery,the latency of Group A was shorter than that of group B(P<0.05).The maximum amplitude of CMAP recorded from the FCU and FDS of Group A was greater than that of Group B,and the difference was statistically significant (P<0. 05). The results of muscle tetanus contraction force test showedthat at 4, 8, and 12 weeks after surgery, the recovery of muscle tetanus contraction force of the forearm flexormuscle group in Group A was better than that in group B, but both Group A and B were lower than Group C,and the differences were statistically significant (P<0. 05). The measurement results of muscle fiber crosssecti

关 键 词：臂丛 神经移位 全臂丛神经损伤 健侧颈7移位 游离神经移植桥接 

分 类 号：R651.3[医药卫生—外科学]