【摘要】 目的通过动物实验,研究运动神经移位寄养提高二期神经修复术疗效的可行性,为其进一步应用于临床治疗提供实验依据。方法取SD大鼠16只,体重200～250g,雌雄不限。随机分为两组(n=8):肌皮神经延期修复组(A组),单纯剪断左侧肌皮神经,造成肱二头肌失神经支配模型,6周后行肌皮神经修复;神经移位寄养二期肌皮神经修复组(B组),剪断左侧肌皮神经后即刻将胸内侧神经分支的近端移位寄养于肌皮神经的远端,6周后结束寄养关系行二期神经修复术。两组大鼠右侧不作处理,为对照。二次术后6、12周分别定期观察比较左上肢屈肘功能和肱二头肌恢复情况,行肌皮神经最大诱发动作电位潜伏期和波幅的检测,并测量肱二头肌湿重、肌纤维横截面积以及Na+-K+-ATP酶的活性,比较神经修复后两组各项指标恢复率。结果二次术后4周,B组左前肢可观察到屈肘梳理毛发的动作,A组6周才偶见左前肢屈肘梳理毛发。二次术后6周,A、B组最大诱发动作电位潜伏期恢复率分别为187.25%±1.97%和155.96%±3.02%,波幅恢复率分别为46.25%±4.63%和51.21%±2.13%,肌湿重恢复率分别为55.14%±1.99%和74.18%±1.82%,肌纤维横截面积恢复率分别为49.97%±1.71%和55.05%±1.64%,Na+-K+-ATP酶活性恢复率分别为65.81%±2.24%和71.08%±1.53%;二次术后12周,A、B组最大诱发动作电位潜伏期恢复率分别为145.36%±3.27%和129.83%±8.36%,波幅恢复率分别为51.84%±5.02%和75.22%±2.78%,肌湿重恢复率分别为77.92%±1.73%和84.51%±1.34%,肌纤维横截面积恢复率分别为61.04%±2.68%和78.75%±3.69%,Na+-K+-ATP酶活性恢复率分别为71.94%±1.65%和84.86%±1.81%。两组在各时间点各指标比较差异均有统计学意义(P<0.05)。结论运动神经移位寄养可使失神经的肌肉保持良好状态,促进二期神经修复术后神经功能恢复。更多还原

【Abstract】 Objective To observe whether the motor nerve babysitter could improve the delayed nerve anastomosis and promote the functional recovery.Methods Sixteen SD rats weighing 200-250 g were randomly divided into 2 groups.In group A,the left musculocutaneous nerve was transected to make the model of biceps brachii denervation and anastomosed to its proximal end 6 weeks later;In group B,the musculocutaneous nerve was transected and the distal end was coapted to the purely motor medial pectoral nerve immediately(nerve babysitter) and the musculocutaneous nerve was separated from the medial pectoral nerve,and reanastomosed to its proximal end 6 weeks later.In the animal model,the left limbs served as experimental sides,the right limbs as control sides.After 6 and 12 weeks of the second surgery,behavioral test(grooming test) was performed and the degree of the biceps brachii atrophy was observed,the latent period and the amplitude of the maximun action potentials of the biceps brachii were detected,the wet muscle weight,muscle ber cross-section area and the activity of Na+-K+-ATPase of the biceps brachii were measured.Results After 4 weeks of the second surgery,grooming behavior was found in group B,while few grooming behavior was seen in group A till 6 weeks after the secondary surgery.After 6 weeks of the second surgery,the recovery rate of the latent period and the amplitude,the wet muscle weight,muscle ber cross-section area and the enzymatic activity of Na+-K+-ATPase of the biceps brachii in group A was 187.25% ± 1.97%,46.25% ± 4.63%,55.14% ± 1.99%,49.97% ± 1.71%,and 65.81% ± 2.24%,respectively,which was signi cantly di erent from that in group B(155.96% ± 3.02%,51.21% ± 2.13%,74.18% ± 1.82%,55.05% ± 1.64% and 71.08% ± 1.53%,respectively,P < 0.05).After 12 weeks of the second surgery,the recovery rate of the latent period and amplitude,the wet muscle weight,muscle ber cross-section area and the enzymatic activity of Na+-K+-ATPase of the biceps brachii in group A was 145.36% ± 3.27%,51.84% ± 5.02%,77.92% ± 1.73%,61.04% ± 2.68% and 71.94% ± 1.65%,respectively,which was signi cantly di erent from that in group B(129.83% ±8.36%,75.22% ± 2.78%,84.51% ± 1.34%,78.75% ± 3.69% and 84.86% ± 1.81%,respectively,P < 0.05).Conclusion Motor nerve babysitting could reduce muscular damage after denervation,improve the e ect of delayed nerve repair and promote the functional recovery of musculocutaneous nerve.更多还原