【作者】 王旭辉；

【导师】 李世亭；

【作者基本信息】 同济大学 ， 神经外科， 2005， 硕士

【摘要】 颅脑损伤、颅底手术常造成动眼神经损伤，导致眼外肌麻痹及眼球运动障碍，严重影响病人的生活质量，迄今为止尚缺乏有效的动眼神经修复方法。人们围绕动眼神经损伤后的功能修复进行了一些基础和临床研究。但是，目前对于动眼神经再生的机制研究尚未达成共识。在上海市科委“动眼神经损伤后功能恢复的研究”(02QB14045)基金资助下，我们主要进行了以下研究：Beagle犬动眼神经损伤动物模型的建立；适用于动眼神经研究的专用刺激电极和引导电极的制作；Beagle犬正常动眼神经电生理学与组织学研究；数学建模与系统仿真研究；动眼神经损伤后不同时间电生理学变化以及一定电刺激在神经修复过程中的作用。第一部分Beagle犬动眼神经损伤动物模型的建立目的建立具有良好可行性及可重复性的Beagle犬动眼神经损伤模型。方法10只雌性Beagle犬常规开颅暴露动眼神经海绵窦后段，将动眼神经锐性切断，再予直接端一端吻合。结果全部实验步骤均能被Beagle犬耐受，幕下段动眼神经暴露充分，神经损伤后可予直接缝合。结论Beagle犬动眼神经损伤动物模型已经建立，并具有良好可重复性，可进一步用于动眼神经损伤后功能修复的研究。第二部分适用于动眼神经研究的专用刺激电极和引导电极的制作目的：制作Beagle犬动眼神经研究的专用刺激电极和引导电极。方法：选用铂金丝、有机玻璃、空心铜管、瑞琪尔针等材料，手工制作适用于动眼神经研究的特定大小、长度的电极。结果：经家兔减压神经放电和迷走神经放电实验证实，刺激电极和引导电极实验性能均良好。结论：Beagle犬动眼神经研究的专用刺激电极和引导电极已经制作成功，两种电极抗干扰能力强、灵敏度高。第三部分Beagle犬正常动眼神经电生理学与组织学研究目的：研究Beagle犬正常动眼神经电生理学与组织学特征。方法：选用雌性Beagle犬8只，分别暴露动眼神经海绵窦后段及同侧下斜肌。采用不同参数的重复方波电刺激动眼神经海绵窦后段，用Med Lab生物信号采集处理系统获取下斜肌复合肌肉动作电位(CMAPs)。应用光镜、电镜技术研究动眼神经纤维组织学特征。结果：获得8只Beagle犬下斜肌CMAPs，电刺激强度为1.7v时，下斜肌放电最大幅度为510μv。结论：实验室的等电位接地与动物的多方位单点接地是获取生物电信号的关键条件，动眼神经由两种组织学特征不同的有髓神经纤维构成。第四部分数学建模与系统仿真研究目的：用函数或方程的形式来描述正常动眼神经电生理学变化规律，并进行系统仿真研究。方法：通过模型简化的方法，应用Simulink软件进行建模和系统仿真。结果：获得本研究系统的数学模型：其中x(t)为激励，y(t)为响应。y=0.54427x~5-2.7671x~4+4.6956x~3-2.8737x~2+0.66571x-0.0019639。结论：建立了正常动眼神经电生理变化的数学模型，经过系统仿真证实了模型的可靠性。第五部分动眼神经损伤后不同时间电生理学变化以及一定电刺激在神经修复过程中的作用目的：探索动眼神经损伤后不同时间的电生理学变化特征，明确电刺激在动眼神经修复过程中的作用。方法：动眼神经损伤后不同时间(1m，2m，3m共三个时间点，每个时间点两只Beagle犬)采集下斜肌CMAPs，观察电生理学变化和神经功能修复。根据数学模型选择0.9731，和1.7v，两种参数电刺激动眼神经，观察3m时电生理和功能修复的情况。结果：动眼神经损伤后电生理出现了明显变化，随时间延长电生理呈动态变化。动眼神经功能出现不同程度的恢复，副交感功能较眼外肌功能恢复早。两种参数电刺激动眼神经3m后发现下斜肌CMAPs明显恢复。结论：动眼神经损伤后电生理随时间出现动态变化，一定的电刺激能促进动眼神经电生理的恢复。更多还原

【Abstract】 Experimental Study on Electrophysiological Mechanism and Functional Recovery of Oculomotor NervesOculomotor nerve injury is often occurred during the brain trauma and craniotomy, which can result in the paralysis of the extraocular muscles and the oculomotor handicap, and then greatly affect the life quality of patients. Hower, up until now the functional recovery of damaged oculomotor nerve is still a tough problem. Recently some scientists have been pursuing the goal of many efficient ways to repair posttraumatic oculomotor nerves. Yet not a general theory was approved on the regenerative mechanism of posttraumatic oculomotor nerves. The paper has been fund by Science & Technology department of Shanghai, ’Study of functional recovery on posttraumatic oculomotor nerves’ (02QB 14045).The following have been included in our study: establishment of the Beagle canines model of oculomotor nerves injury; making up the stimulating electrode and recording electrode to be specialized in our experimental study; to explore the electrophysiological and histological characteristic of normal oculomotor nerves; to establish a mathmatical model and to simulate by Biocybemetics; to investigate the changes on electrophysiological aspect of posttraumatic oculomotor nerves and the effect of electric stimulus during recovery ofposttraumatic oculomotor nerves.PartⅠ: Establishment of the Animal Model of Oculomotor Nerves InjuryObjective To create more feasible and reproducible dog model of oculomotor nerves injury. Methods The posterior segments of oculomotor nerves in cavemous sinus were exposed in 10 Beagle canines after craniotomy, different neurophysiologic parameters were administrated, and the compound muscle action potentials(CMAPs)of obliquus inferior muscle were recorded successfully. After cutting of the oculomotor nerves, end-to-end anatomosis were used to anatomical reconstruction of the damaged oculomotor nerves immediately. Results All the procedures used in the study have been well tolerated by Beagle canines. Ocolomotor nerves were exposed completely, end-to-end anatomosis were done successfully. Conclusion The animal models have been established to study on the functional reconstruction and shown great reproducibility .The study will serve as the foundation for the development of a lager animal to research the reconstruction of the oculomotor nerves and other cranial nerves.PartⅡ: making up the stimulating electrode and recording electrode to be specialized in our experimental studyⅡObjective To make up the stimulating electrode and recording electrode which can be used to study on electrophysiological characteristic of oculomotor nerves. Methods Some primitive material were chosen to make up hand-made electrodes to meet the experimental study, such as Platinum, Lucite, Acupuncture needle. Results Property of the stimulating and recording electrodes was confirmed well by the depressor nerve and vagus nerve discharge in rabbits. Conclusion The electrodes have been maken up successfully to study on the electrophysiological characteristic of Beagle canines’ oculomotor nerves, and the property of sensitivity and anti-interference has met the experimental need.PartⅢ: The electrophysiologicai and histological characteristic of normal oculomotor nerves in Beagle caninesObjective To investigate the electrophysiological and histological characteristic of normal oculomotor nerves in Beagle canines. Methods The posterior segments of oculomotor nerves in cavernous sinus were exposed in 8 Beagle canines after craniotomy, different neurophysiologic parameters were administrated, and the compound muscle action potentials(CMAPs)of obliquus inferior muscle were recorded by Med Lab System. Histological aspects of oculomotor nerves were observed with light microscope and electron microscope. Results Ocolomotor nerves were exposed completely, and bioelectrical signals were acquired successfully. The maximum amplitude of bioelectrical signals is about 510μv. Conclusion The key point to attain ideal signals is indeed earthing model. The oculomotor nerve was made of two kinds of fibers with different diameter and myelin sheath.PartⅣ: The establishment of mathmatical model and the Simulation by BiocyberneticsObjective To describe the electrophysiological law by Function in Mathematics or Equation, and to simulate by Biocybemetics. Methods The mathmatical model and Simulation were done by Simulink. Results The expression of Function in Mathematics is y=0.54427x~5-2.7671x~4＋4.6956x~3-2.8737x~3＋0.66571x-0.0019639. Conclusion The mathmatical model proved by Simulation has been established successfully.Part V: The changes on electrophysiological aspect of posttraumatic oculomotor nerves, and the effect of electric stimulus during recovery of posttraumatic oculomotor nervesObjective To explore electrophysiological changes of oculomotor nerves in different time points ,and to observe he effect of electric stimulus during recovery of posttraumatic oculomotor nerves. Methods The CMAPs of obliquus inferior muscle were recorded successfully in different time points. Two electric stimulus models were applied to observe the recovery of posttraumatic oculomotor nerves. Results There is a developmental changes on electrophysiological aspects of posttraumatic oculomotor nerves .The function of posttraumatic oculomotor nerves can recover partly, but the recovery of sphincter muscle of pupil was earlier than that of extraocular muscles. The CMAPs of obliquus inferior muscle were recovered significantly at the third month in electric stimulus group. Conclusion Developmental changes were showed on electrophysiological aspects of posttraumatic oculomotor nerves, and electric stimulus is benefit for the functional recovery ofposttraumatic oculomotor nerves.更多还原